Clinical Reasoning Cycle Leonard

Question: Discuss about the Clinical Reasoning Cycle Leonard's Falls And Other Health Risk Factors. Answer: Introduction Effective clinical reasoning skills are vital for a nurse to improve patients health condition and ensure positive outcomes. The process of clinical reasoning developed by Levett Jone is the cycle of linked and ongoing clinical situations (Dalton et al. 2015). The paper deals with the case study of Leonard who is presented to the acute medical ward after fall. The report discusses Leonards falls and other health risk factors using the reasoning cycle framework. The report further critically evaluates the best-practice assessment tools appropriate for the case. Lastly, the report presents the support given to Leonard applying the person-centred approach while meeting the obligations as health professional. Leonards falls and other health risk factors Collection of information As per the case history of Leonard, his age is 65 years. He is admitted to acute medical ward by the Emergency Department after falling at local shop. He did not sustain a fracture, although he had severe bruising of his face and hip. He is diagnosed with decompensate liver disease due to heavy alcohol intake (40 g/day for last month). His clinical handover shows present symptoms of anorexia, dyspnoea, jaundice, and lethargy. He was not coping with his illness prior to his admission. His admission history shows mental and behavioural disorder due to alcohol dependence, a decubitus ulcer on the shin of his left leg, anaemia, industrial deafness, some evidence of urinary incontinence, mild hypotension, lower limb oedema, and regular falls. After his wife death, Leonard has lost support system. He lives in a single storey house, with four steps to the front and two steps at the back with no rails. He lives with his housemate, who is mentally ill and rarely home. He receives mild support from his two elder sisters. Over the last six months, he is unable to carry his activities of daily living independently. In addition, he has some evidence of urinary incontinence and lower limb oedema. He had a Mini Mental State Examination (MMSE) score of 28/30, but appears to have little insight into his problems and also exhibits motor planning difficulties. In addition, Leonard also has industrial deafness as he worked as boilermaker in a very noisy factory. The patient denies support services at home; however, he is keen to return home. The cause of physical deterioration was due to range of manual and labouring jobs. He is mostly restricted to home with no entertainment. Process of information Leonard has severe risk of fall in future as he his physically fragile. His physical frailty is also evident from his need of walking frame for mobility. Recently, his functioning has detoriated due to which he is not able to perform his activities of daily living independently. Due to dyspnoea, anorexia, arthritis in his lower back, mild hypotension, he is at risk of poor physiologic condition and poor mobility (Shen et al. 2015). According to Soenen and Chapman (2013. P. 643) lack of grab rails on the toilet is adding to the risk of fall. Adding to the risk is his muscle weakness, poor balance and risk of gait. MMSE score of 28/30 is indicative of normal cognition. However, Motor planning difficulties and confusion can lead to frequent accidents and decrease confidence (Schoene et al. 2014). He needs dietitian to maintain healthy nutritional status, as he is anorexic and anaemic. His alcoholic liver disease also increases the risk of gastrointestinal tract upset. His symptoms of dyspnea increase the risk of respiratory diseases (Yeluru et al. 2016). Leonard has poor coordination and is not mentally alert. It is evident from his poor planning of tasks and inability to get dressed (Mihaljcic et al. 2015). He lacks support and care needed as he lives alone with his housemate too has mental illness. He receives inadequate support and assistance from his two elder sisters. He was in bereavement after his wifes death due to cancer. It may have caused him to developed fear of hospitals. This fear is depriving him of receiving adequate physical and mental health care (Keyes et al. 2014). His alcohol dependence is also the outcome of his bereavement and has caused decompensate liver disease. He lacks love, belongingness and affection, which is decreasing his coping with illness ( Feng et al. 2014). Lack of family members support and hearing impairment decreases social life and depression. It decreases functional and emotional status. Leonard has low energy to take part in recreational activities such as gardening and fishing. Financial constraints in addition to illness may be adding to the depression (Roets-Merken et al. 2015). In conclusion, Leonard has high risk of fall. In addition to that, other health risk factors of Leonard include Increased risk of mortality due to alcoholic liver disease, Decreased independency to perform activities of daily living, Development of depression and anxiety, Neglecting personal hygiene, Risk of gastrointestinal tract upset Risk of respiratory disease Risk of poor social connectedness due to hearing impairment, poor mobility and motor planning difficulties Three best-practice assessment tools appropriate for this case The three best practice assessment tools appropriate for this case are Falls Risk Assessment Tool or FRAT, Mini-mental state examination or MMSE, and Alcohol use screening assessment tool. The best practice assessment tools for Leonard for his fall are Peninsula Health FRAT. It is commonly used in Australia for elderly people living in community (Hill et al. 2016). The study evaluating the reliability and validity of FRAT has been published in Cattelani et al. (2015). FRAT has three sections. The first section assesses falls risk status followed by the second section consisting of risk factor checklist and the last section dealing with action plan. The tool requires approximately 15-20 minutes. The tool has criterion that is Medium risk: score of 1215 and a High risk: score of 1620. This assessment tool gives detailed information on the underlying factors contributing to the patients fall. It serves as screening test only The best practice assessment tools for cognition are MMSE. This tool is effective for grading the cognitive state of the client. The tool gives information on the degree of cognitive impairment (out of 30 if the score is 21-24 then it is mild impairment, 10-20 as moderate and The third assessment tool appropriate for Leonard is the Short Michigan Alcoholism Screening Instrument Geriatric Version (SMAST-G). The instrument has scoring system where a score of 2 or more responses for Yes indicates the alcohol dependency problem. This tool is the first step to develop interventions and referral to treatment (Taylor et al. 2014). Nurses can use the scores to determine the degree to cut alcohol intake when scored high above the recommended state. In older adults the score helps to determine the risk of depression, anxiety, gastrointestinal problems. The instrument can only be used for screening and has been commonly used for older adults who are drinking at higher levels. The tool has been found to have high sensitivity and specificity. The feasibility and the acceptability of the tool has been tested and its reliability and validity has been published in Randall-James et al. (2015) Person-centred approach to support Leonards rights In nursing practice, person-centred care is essential to improve patients health outcomes. As a nurse, focus will be put on Leonards individual needs and goals. The family member of the client will be involved as appropriate. His right of autonomy will be ensured by involving him in making heath related decisions. His rights to access health care information, treatment options and express personal concerns will be maintained. The patients right to dignity will be maintained by knowing the patient as an individual, being responsive, and respecting his values, needs and preferences. While caring and promoting physical and emotional comfort emphasis will be given on his freedom of choice. Patients Privacy will be respected while caring and confidentiality of the information will be protected. The standards set by the Nursing and Midwifery Board of Australia in respect to the code of ethics will be complied. The standards set by the board will be strictly followed for providing the right care to the patient considering the spiritual, cultural and ethnic factors (Gray et al. 2016). Conclusion The paper has highlighted the health risk factors of Leonard supporting with literature. It has discussed the effective assessment tools for Leonard. In conclusion, nurses need effective clinical reasoning skills to identify the health risk factors and priority needs of patient. Nurse must be aware of the necessary tools for health assessment of patients to develop effective care plan. Nurses must protect patients rights, as it is important for their satisfaction of health care services. Nurses need to be competent in implementing the person centred approach and must be efficient in placing the patients needs above those identified as priorities by the heath cafe professional. References Cattelani, L., Palumbo, P., Palmerini, L., Bandinelli, S., Becker, C., Chesani, F. Chiari, L., 2015. FRAT-up, a web-based fall-risk assessment tool for elderly people living in the community.Journal of medical Internet research,vol. 17, no. 2. Dalton, L., Gee, T. Levett-Jones, T., 2015. Using clinical reasoning and simulation-based education to'flip'the Enrolled Nurse curriculum.Australian Journal of Advanced Nursing, vol. 33, no.2, p. 29. Feng, L., Nyunt, M.S.Z., Feng, L., Yap, K.B. Ng, T.P., 2014. Frailty predicts new and persistent depressive symptoms among community-dwelling older adults: findings from Singapore longitudinal aging study.Journal of the American Medical Directors Association,vol. 15, no. 1, pp.76-e7. Gray, M., Rowe, J. Barnes, M., 2016. Midwifery professionalisation and practice: Influences of the changed registration standards in Australia.Women and Birth,vol. 2, no. 1, pp.54-61. Hill, K.D., Flicker, L., Logiudice, D., Smith, K., Atkinson, D., Hyde, Z., Fenner, S., Skeaf, L., Malay, R. Boyle, E., 2016. Falls risk assessment outcomes and factors associated with falls for older Indigenous Australians.Australian and New Zealand journal of public health,vol. 40, no.6, pp.553-558. Keyes, K.M., Pratt, C., Galea, S., McLaughlin, K.A., Koenen, K.C. Shear, M.K., 2014. The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study.American Journal of Psychiatry,vol.171, no. 8, pp.864-871. Mihaljcic, T., Haines, T.P., Ponsford, J.L. Stolwyk, R.J., 2015. Self-awareness of falls risk among elderly patients: characterizing awareness deficits and exploring associated factors.Archives of physical medicine and rehabilitation,vol. 96, no. 12, pp.2145-2152. Mitchell, A.J., 2017. The Mini-Mental State Examination (MMSE): update on its diagnostic accuracy and clinical utility for cognitive disorders. InCognitive Screening Instruments.Springer International Publishing, pp. 37-48. Randall-James, J., Wadd, S., Edwards, K. Thake, A., 2015. Alcohol screening in people with cognitive impairment: an exploratory study.Journal of dual diagnosis,vol. 11, no.1, pp.65-74. Roets-Merken, L.M., Draskovic, I., Zuidema, S.U., van Erp, W.S., Graff, M.J., Kempen, G.I. Vernooij-Dassen, M.J., 2015. Effectiveness of rehabilitation interventions in improving emotional and functional status in hearing or visually impaired older adults: a systematic review with meta-analyses.Clinical rehabilitation,vol. 29, no. 2, pp.107-119. Salminen, H., Zary, N., Bjrklund, K., Toth-Pal, E. Leanderson, C., 2014. Virtual patients in primary care: developing a reusable model that fosters reflective practice and clinical reasoning.Journal of medical Internet research,vol. 16, no. 1, p. e3. Schoene, D., Valenzuela, T., Lord, S.R. de Bruin, E.D., 2014. The effect of interactive cognitive-motor training in reducing fall risk in older people: a systematic review.BMC geriatrics,vol. 14, no. 1, p.107. Shen, H.W., Feld, S., Dunkle, R.E., Schroepfer, T. Lehning, A., 2015. The prevalence of older couples with ADL limitations and factors associated with ADL help receipt.Journal of gerontological social work,vol. 58, no. 2, pp.171-189. Soenen, S. Chapman, I.M., 2013. Body weight, anorexia, and undernutrition in older people.Journal of the American Medical Directors Association,vol. 14, no. 9, pp.642-648. Stein, J., Luppa, M., Kaduszkiewicz, H., Eisele, M., Weyerer, S., Werle, J., Bickel, H., Msch, E., Wiese, B., Prokein, J. Pentzek, M., 2015. Is the Short Form of the Mini-Mental State Examination (MMSE) a better screening instrument for dementia in older primary care patients than the original MMSE? Results of the German study on ageing, cognition, and dementia in primary care patients (AgeCoDe).Psychological assessment,vol. 27, no. 3, p.895. Taylor, C., Jones, K.A. Dening, T., 2014. Detecting alcohol problems in older adults: can we do better?.International psychogeriatrics,vol. 26, no. 11, pp.1755-1766. Yeluru, A., Cuthbert, J.A., Casey, L. Mitchell, M.C., 2016. Alcoholic Hepatitis: Risk Factors, Pathogenesis, and Approach to Treatment.Alcoholism: Clinical and Experimental Research,vol. 40, no. 2, pp.246-255.

There Are Many Bands And Different Kinds Of Music I Like To Listen To.

There are many bands and different kinds of music I like to listen to. I like to listen to many different bands and songs. When I listen to music I listen for the beat as long as listen for the lyrics. Even with all the different types of music around I mainly like to listen to hard rock. I like to listen because of the hard guitars and the streaming drums. Music to me is a way to relax. I enjoy listening to music. I listen to it so much now in many different places that it is a thing I really do not notice anymore. For this abstract there were many songs that I had to choose from. The types of songs that I chose were songs that make me feel a certain way every time I hear them. The three songs that I chose were songs that I have come to like and not songs that plays every two seconds on the radio. The first song that I chose is by a group called Nine Inch Nails. They are a pretty heavy music group. I chose a song that just come off their most recent album called The Fragile. The name of the song is called the wretched. I think this song means many different things. This song is a more serious depressing song. I think it has to do with someone who is having a real hard time. They are stuck in a hole and cannot really get out. This person has been pushed down and cannot really get back up. This song kind of makes me feel like it cannot always be good sometimes. I think there can be very many ways to express this song in many different ways but the lyrics made this song so good. It is so good because it does not just talk about being in a gang and talking about killing or beating someone. I like the way the lyrics come out. The next song is from the same group and same cd. The song is the fragile. This is a lighter kind of song. Even though I really do not like the typical kind of love song, this song kind of really stands out to me. I like how this song does not just talk about leaving someone of they are not perfect but staying with them and helping them. This song to me talks about someone that they love and everything has not really gone to well. Everything is falling apart and this person won't let it. This person has gone through the same thing and wont let it happen again. I like the lyrics and the beat is really good. The third song I chose is from the same CD and band is well. If had to bring our favorite CD off all time this would be the CD I would bring. The third song I chose is even deeper. I like this song very well and the meaning of the song is very clear. This song is about a relationship that has fallen apart. This person wants to leave but they cannot and they always come back. They are lost and the always can't stay way. I think this person is trying to overcome this other person but they just stay. Bibliography dave

Sarbanes-Oxley Act Article Essay Essays

Sarbanes-Oxley Act Article Essay Essays Sarbanes-Oxley Act Article Essay Essay Sarbanes-Oxley Act Article Essay Essay Section 404 of the Sarbanes-Oxley ActThis article reappraisal is on the article written by David S. Addington called â€Å"Congress Should Repeal or Fix Section 404 of the Sarbanes-Oxley Act to Help Create Jobs. † The Heritage Foundation published the article on September 30 2013. In the article. the writer addresses concerns among companies remaining in conformity with Section 404 of the Sarbanes-Oxley Act. The writer indicates that subdivision 404 of the Sarbanes-Oxley act has caused a fiscal load on companies. Companies spend a big sum of money to remain in conformity with the ordinances on subdivision 404 of the Sarbanes-Oxley Act. Furthermore. companies could utilize the money spent on scrutinizing fiscal records to put in more concern lines and make more occupations ( Additon. 2011 ) . Section 404 of the Sarbanes-Oxley Act requires companies to include a statement of the duty of the company direction for â€Å"establishing and keeping an equal internal control construction and processs for fiscal reporting† along with their study filed with the Securities and Exchange Commission ( SEC ) . The one-year study must include an appraisal of the effectivity of the company’s internal control construction and processs for fiscal coverage. followed by holding a registered public accounting house â€Å"attest on. and study on the appraisal made by the direction. † This facet of the statute law requires companies to document of import fiscal paperss along with the reappraisal from the certified public accounting house ; it requires enormous attempt and big sums of money for companies to follow with this facet of the Sarbanes-Oxley Act ( Additon. 2011 ) . The writer indicates that companies can utilize the money spent by companies to remain in conformity o n other concerns lines ; making more occupation chances and profiting the economic system. The writer demands that Congress should analyze whether subdivision 404 is needed. and if so. how to cut its dearly-won load on concerns. Modifying or revoking subdivision 404 of the Sarbanes-Oxley Act can liberate concerns to excite the economic system ( Additon. 2011 ) . Businesses must remain in conformity with the jurisprudence to run expeditiously at all times. Companies should remain in conformity to acquire the assurance and trust from investors. The 2012 Sarbanes-Oxley Compliance Survey listed where companies stand on reexamining cost. clip. attempts. processes to remain in conformity with the ordinances. Approximately 35 % of midsize organisations spend from $ 100. 000 to $ 500. 000 yearly. and about 80 % spend $ 1 million or less. By twelvemonth four of Sarbanes-Oxley conformity. most organisation are passing $ 100. 000 to $ 500. 000 yearly ( 2012 Sarbanes-Oxley Compliance Survey ) ; this is comparatively a little sum of money compared the entire sum the company really makes. The Sarbanes-Oxley act protects the populace from unethical behaviour by companies. If the authorities does non keep companies accountable for their funding. it will take to unconfident investors in the market ; if the populace is non puting in concerns the economic system will non be better. The award the company pays to remain in conformity with the Sarbanes-Oxley Act is at the right monetary value. accomplishing trust. and assurance from the popula ce. MentionsDavid S. Addington â€Å"Congress Should Repeal or Fix Section 404 of the Sarbanes-Oxley Act to Help Create Jobs. † The Heritage Foundation. September 30. 2011. Web. Retrieved from: hypertext transfer protocol: //www. heritage. org/research/reports/2011/09/congress-should-repeal-or-fix-section-404-of-the-sarbanes-oxley-act-to-help-create-jobs 2012 Sarbanes-Oxley Compliance Survey. Retrieved from: hypertext transfer protocol: //www. protiviti. com/en-US/Documents/Surveys/2012-SOX-Compliance-Survey-Protiviti. pdf

How to Graduate With a Bachelors Degree Faster

How to Graduate With a Bachelor's Degree Faster Many people choose distance learning for its convenience and speed. Online students are able to work at their own pace and often finish faster than traditional students. But, with all the demands of daily life, many students  search for ways to complete their degrees in even less time. Having a degree sooner may mean making a larger salary, finding new career opportunities, and having more time to do what you want. If speed is what you’re looking for, check out these six tips to earning your degree as quickly as possible. Plan Your Work. Work Your Plan Most students take at least one class that they don’t need for graduation. Taking classes unrelated to your major field of study can be an excellent way to expand your horizons. But, if you’re looking for speed, avoid taking classes that aren’t required for graduation. Double-check your required classes and put together a personalized study plan. Staying in contact with your academic advisor each semester can help you stick to your plan and stay on track. Insist on Transfer Equivalencies Don’t let work you’ve done at other colleges go to waste; ask your current college to give you transfer equivalencies. Even after your college has decided what classes to give you credit for, check to see if any of the classes you have already completed could be counted to fill another graduation requirement. Your school will probably have an office that reviews transfer credit petitions on a weekly basis. Ask for that department’s policies on transfer credits and put together a petition. Include a thorough explanation of the class you have completed and why it should be counted as an equivalency. If you include course descriptions from your previous and current schools’ course handbooks as evidence, chances are you’ll get the credits. Test, Test, Test You can earn instant credits and reduce your schedule by proving your knowledge through testing. Many colleges offer students the opportunity to take the College Level Examination Program (CLEP) exams in various subject matters for college credit. Additionally, schools often offer their own exams in subjects such as foreign language. Testing fees can be pricey  but are almost always significantly lower than tuition for the courses they replace. Skip the Minor Not all schools require students to declare a minor and, truth be told, most people won’t make too much of a mention of their minor during the life of their career. Dropping all minor classes could save you an entire semester (or more) of work. So, unless your minor is critical to your field of study or would bring you foreseeable benefits, consider eliminating these classes from your plan of action. Put Together a Portfolio Depending on your school, you may be able to get credit for your life experience. Some schools will give students limited credit based on the presentation of a portfolio that proves specific knowledge and skills. Possible sources of life experience include  previous jobs, volunteerism, leadership activities, community participation, accomplishments, etc. Do Double Duty If you have to work anyway, why not get credit for it? Many schools offer students college credits for participating in an internship or work-study experience that relates to their major – even if it’s a paid job. You may be able to get your degree faster by earning credits for what you already do. Check with your school counselor to see what opportunities are available to you.

Kellogg Briand Pact and the Ethiopian Invasion of Italy Research Paper

Kellogg Briand Pact and the Ethiopian Invasion of Italy - Research Paper Example The pact was proposed in 1927 by Aristide Briand the then foreign minister of France. Briand proposed to the government of the US the establishment of a treaty prohibition war between the two nations (Special Cable 1935, 1). The US Secretary of State Franc Kellogg agreed to Briand’s proposal and proposed that the pact encompasses other nations in the deterrence of war among nations. After intense negotiations, the Kellogg-Briand pact encompassed 15 nations including among others Italy, New Zealand, Britain, the US, Germany and South Africa. Parties that accepted the contract agreed that, despite the origin and nature of conflicts among the contracting parties, neither party would use war as a medium of national policy. While up to 62 states eventually ratified the pact, the effectiveness of the Kellogg-Briand was eventually impaired by its inability to provide guidelines of enforcement. In addition, many nations gave the pact a rather unenthusiastic reception because most stat es recognized war as the sole solution to conflict resolution. It is essential to, however, note that while the Kellogg-Briand pact did not advocate resolution to war, the pact acknowledged the right of states to defend their integrity when under attack. The ineffectiveness of the Kellogg-Briand pact is also apparent because no nation or entity was given the authority to ensure all parties abide by the provisions of the pact. Apparently, the pact did not make any substantive contributions to ensuring international order in most cases. However, in 1929, the pact was invoked rather successfully when the USSR and China arrived at a tense moment regarding possession of the Chinese Eastern RR located in Manchuria (George 1969, 308). However, the Kellogg-Briand pact proved to carrying no significant weight, especially because of the practice of engaging in undeclared wars during the 1930s. Such undeclared wars include the 1931 invasion of Manchuria by the Japanese, German’s 1938 oc cupancy of Austria and Italy’s invasion of Ethiopia in 1935. This section of the paper will examine Italy’s invasion of Ethiopia in the year 1935, and discuss the effects of the Kellogg-Briand pact, if any. The war between Italy and Ethiopia, or the Second Italo-Abyssinian War as it is often referred occurred in 1935 between Fascist Italy and the Empire of Ethiopia. The war between the two nations is notable because of Italy’s use of underhanded strategies against Ethiopia (Mark 2001, 239). For instance, Italy’s illegal utilization of mustard gas clearly contravened the Kellogg-Briand pact. Italy, being a signatory of the pact had contravened the essence of the pact by engaging in undeclared and unwarranted warfare against Ethiopia because of Italy’s desire to annex Ethiopia, which was still uncolonized at the time. Perhaps the reason why Italy sought to annex Ethiopia was its inability to do so in the 19th century. When Italy acquired nations such as Eritrea and Somaliland, it was unable to annex Ethiopia. Italy’s invasion of Ethiopia exposed the inherent limitations of the League of Nations because the league was unable to protect Ethiopia or control Italy. This was despite the fact that both nations were its members and Italy was a

Assign 1) Chpt 6 & 7 Assign 2) Soci DB Essay Example | Topics and Well Written Essays - 500 words

Assign 1) Chpt 6 & 7 Assign 2) Soci DB - Essay Example In the turn of old age or physical weakness, the spouse must be able to take hold of that responsibility of taking care of his or her partner, and it is only in that way that they can justify what long-term relationship means. Commitment has a particular role to play in long-term relationships. In an episode about marriage in the Oprah Show, there was one thing that she told her guests that really struck me. Oprah said that you will not be in love everyday in the entire course of your marriage and it takes your choice and effort to be in love. This is true about intimacy in long term relationships. This kind is not limited to heterogeneous relationships, because human emotions do not know any gender. What the heart feels is just the way it is, but the relationship existing between the couple, whatever their genders are, is universal. Long term relationships cannot stand with love alone, as love has the tendency to outgrow and consequently ending the emotion. Whereas if a long term-re lationship would rest in commitment, responsibility, acceptance, and respect, there is more chance for love to grow.

Summary of the Lesson Essay Example for Free

Summary of the Lesson Essay Introduction Class 2a is a mixed year group, with 13, more able, year one pupils and 16, less able, year two pupils. The differentiation by the classroom teacher tends to centre around ability grouping with a total of four grouped sets, two for each year group within the class. The lesson to be described took place on Wednesday 22 October by which time the class had been together for just six weeks. I had received a total of eight hours contact time with the children prior to the implementation of the lesson. The class dynamics were such that the majority of year two pupils appeared less focused and more disruptive than the children from year one, who generally, exhibited better levels of concentration. Summary of the Lesson The lesson was to be on forces and movement, for reasons to be explained following this summary the activity was to involve children experimenting with a variety of artificial surfaces that were to be placed on a board and raised by means of wooden blocks. A toy car was then to be placed on the ramp and the number of blocks noted down when the toy car rolled down the ramp to the bottom. The lesson was to begin with a discussion in which children were encouraged to inform me of their previous experience of using ramps as well as their own experience outside of school, riding a bike or other vehicle down a hill. Questions about riding bikes, skateboards etc on grass or on roads were also raised. Some different material was then to be introduced and passed around for the children to touch and comment on. The proposed surfaces included sandpaper, underlay (which was to be used upside down), woollen carpet, corrugated cardboard and bubble-wrap. A question about how builders decide what to make the road with was put to children who were there guided towards the word testing. Children were then told that we were to find out the best surfaces with which to build a new road, but we were only allowed to use the materials they had just been shown. The children were then to propose which surface might suit our needs best (predict) before been guided towards proposing an investigation. At the end of the lesson the children were to feedback their results (one response in particular was very interesting, details to follow) and to say if and why their predictions differed form their findings. Rationale Areas to be addressed when planning a Science Lesson. Having agreed to teach the whole class a science lesson it was then suggested that any activity I do, should link to the current topic of Forces and movement. Planning began by looking at the existing medium term planning. Appendix ii. In addition to the existing planning, the structure of the lesson was also guided by theories of child development. Learning theory Wittrocks view of learning as discussed in Learning in Science by Osborn and Freyberg (1985) proposes that to learn with understanding learners must themselves actively construct, or generate, meaning from sensory input While Piaget, as discussed in Gill Nicholls book, Learning to Teach observed that children learn faster when they co-operate with others; this co-operation develops and improves their formal thinking (page 41) On the basis of Wittrocks views I wanted the children of class 2A to perform an investigation for themselves, with as little adult intervention as possible. It was important that I accommodated Piagets observation, ensuring that the children work in groups to generate elements of co-operative working. This in turn raised additional issues of inclusion, which I will address later. Questioning The importance of teacher and pupils asking questions became increasingly obvious the teacher must accept all answers and questions as valuable and treat them seriously. Therefore a conscious effort was made to incorporate different types of questions to aid understanding and in turn to encourage children to raise their own questions. Childrens questions are important to their learning because it is often through asking questions that they make the link between one experience and another Making Progress in Primary Science, Harlen et al, RoutledgeFalmer, London (2003) Page 28 I planned to ask closed questions for the less able pupils (appendix ii) Which surface did our investigation show to be the best surface? How many blocks did we use before the car started to move when we used the sandpaper? Through to questions that require a greater level of thinking: Can you tell me why the results differed between groups even though we used the same types of cars? Knowledge, Skills and Understanding The National Curriculum specifies that in addition to being taught about scientific knowledge and understanding they should also be taught how to use the process skills that are important to scientific investigation. Not only are these skills useful in the context of a scientific investigation the skills can also be important in other subjects in the National Curriculum, history being the most obvious. In addition to this the development of scientific skills are needed for making sense of new experiences in the future and for learning throughout life. Teaching of science in primary schools, Harlen, W, Page 56 These process skills include: observing (using senses to collect evidence, quantifying) raising questions (asking questions that can be scientifically investigated) hypothesising (offering possible reasons) predicting (using knowledge or available evidence to predict a likely outcome) interpreting (draw a conclusion based on evidence generated) communicating (presenting results, discussing conclusion) adapted from Teaching of science in primary schools, Harlen, W, Page 18 The National Curriculum recognises the skills required in science. SC1, Scientific Enquiry, page 78, lists the skills that children should have developed by the end of year 2. They evaluate evidence and consider whether tests or comparisons are fair. The concept of a fair test was an area that I planned to highlight during the period of the lesson when the children would be guided towards suggesting an investigation. (appendix ii) Children to be asked about where to place the car? Why do we place the car in the same place each time? Summary of Rationale The elements of a lesson that a trainee teacher, as well as a qualified teacher, must consider while planning a lesson are numerous. During this initial discussion I have touched on a number of them including child development, teacher questioning, pupil questioning and development of process skills. These four elements influenced the planning of the lesson more than any others. However the area that facilitates inclusive teaching also has very important implications on many areas of teaching, organisations and childrens learning including: presentation (techniques can be more attractive to some learners than others) grouping (mixed sex sets, mixed abilities, risk of children dominating) differentiation (providing for the various ability levels) recording methods (how are children to record the findings) It is this area and its influence on planning that I will now explore. Learning styles and the presentation of the lesson. The range of teaching methods employed will have different appeals to the different type of learning, these being: Visual (written word, pictures, videos, wall charts) Auditory (spoken word, discussion) Kinesthetic (movement, hands on activity, role play, drama) Adapted from Shaw Hawes, Effective teaching and learning in the primary classroom (page 53) While all children and adult are capable of learning through anyone of these senses many find that they have a preference. The nature of scientific enquiry will tend to be one of a practical activity. Consequently there is a danger of excluding 50% of the classroom, as research has shown that boys tend to prefer this type of learning: boys generally prefer to engage in noisy, physical competitive games that involve them in manipulating or throwing objects. In contrast, girl generally prefer quieter and more cooperative activities, often involving role-play and verbal interaction. Shaw Hawes, Effective teaching and learning in the primary classroom (page 65) In order not to disassociate the children that dont learn in a manipulative, kinesthetic, activity, I decided to build in a co-operative element within the activity. As discussed in the lesson plan, part one (see appendix ii); children will be required to pass the duties around the whole of the group. This also meant that children were always participating or about to participate in the activity, the effect of this was to ensure that all the children stayed on task throughout the investigation. Grouping Children were to be grouped in their registration sets. This provided each of the four groups with mixed sex groups. As a consequence the children were then with other children from the same age group, preventing the possibility that the older children with pourer concentration did not take over the activity, allowing the year one pupils to work at their own pace. Allowing me to differentiate my questioning during the activity. Recording Methods Two work sheets were devised allowing for differentiation in task, with more able pupils being required to write a little more and select their own material to investigate. At the teachers recommendations the additional worksheet and the requirement of children to select their own surfaces to investigate were omitted. It was suggested that this would only confuse the children. Instead I was asked to be more prescriptive. I believe my original lesson showed a higher level of expectation and was uneasy with the changes to be made. However, I felt it better to respect the class teachers experience and follow her recommendations, not least because I had only been with the class for a short period and did not know them very well. Assessment of Childrens Learning The children successfully identified and applied the principles of fair test (appendix i) the assessment of this was done during the lesson through questioning, observation and listening. They discussed their finding both immediately after the activity and also the following morning, during an oral mental starter in numeracy. Using the table of results to help understanding ordinal value. Fair test was again raised and more children offered answers than on the previous day. The children made their own predictions using both the sense of touch and sight. Through discussions during the lesson and in the plenary I was able to question the children about their predictions and whether or not the evidence would support their view or cause them to change their mind. (see appendices for observation notes of children questioned). During the plenary the children identified the winner of the test. Many of the children identified why the sand paper was the more appropriate of the surfaces to use, some of the children describing the surface as smooth which initially confused me but in the context of the other surfaces used seemed acceptable for key stage one. for opportunities for assessment have to be seized as part of the normal everyday teaching process, rendering assessment as close as possible to a natural teaching situation. A guide to teaching practice, Cohen, Manion and Morrison (2003) Assessment for assessments sack however is not acceptable. Findings should be fed back into the planning process. For example if assessment shows that children do not understand a small concept or continue to hold misconceptions then there is little or no reason for moving the learning on. Planning needs to provide both feedback and feedforward, showing what children have achieved and how this will enable them to move on. Jones D, (2000) Where am I going?: planning and assessing progress in literacy. In Fisher and Williams (Eds.) Unlocking Literacy, a guide for teachers, David Fulton (page 95). Conclusion Timing Had I followed my planning and allowed the children to use elastic bands to add an extra dimension to the lesson, the effect would have been to double the activity time. The guidance of the class teachers saved me from running over time. Timing is an area that I must develop. Initially by drawing further on the experience of qualified teachers and eventually through trial and error. Questioning, scaffolding learning Children provided the ideas for the investigation. Although I deliberately gave them all the clues, such as talking about ramps, showing them surfaces and giving them a context in which they were to work. Use of language in creating misconceptions Scientific language carries specific meaning. Children will often have experience of words outside of their scientific meaning. For example; That isnt a plant. Its a weed! Self Assessment Even after careful planning of questions, I found myself using language that children would be unlikely to understand. This is an area that I struggled with and must work on. The classroom teacher also pointed this out to me as an area that I will develop in time. It is important that I level my questioning and phrasing appropriately to the children I am to teach if I am not to lose their interest. While the class teacher agreed with many of my observations and assessments of her class, the subjective nature of this type of assessment did not sit comfortably with me. This again is an area I must develop my confidence in. The structured nature of the task led to a positive learning environment. All the children took part in the activity and the majority of the class answered questions through out the session. The children worked co-operatively and showed an understanding an ability to apply the principle of fair test. 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