Adaptation and empathy : intercultural communication in a choreographic project

The tricky terrain of intercultural communication within the pressure-cooker environment of creating new performance work is explored through the experiences of five Australians working with 55 artists in Hanoi, Vietnam on a project called Through the Eyes of the Phoenix. Key cultural communication issues such as the concept of ‘face’, identity, translation, adaptability, ambiguity tolerance, empathy, enmeshment and the development of shared understandings are examined in relation to theories of high and low context cultures and individualist collectivist frameworks. The experiences of both Australian and Vietnamese artists are foregrounded, revealing the importance of other intercultural communication modes such as visual, kinaesthetic and tactile languages as well as the languages of their art forms. Immersion in social activities and the importance of the emotional domain are also highlighted as essential factors to survive and thrive in intense creative collaborations across cultures. These dance perspectives, embedded in practice, provide alternative contributions to the messy complexities of intercultural communication.

Perceptions of clinical safety climate of the multicultural nursing workforce in Saudi Arabia : a cross-sectional survey

Purpose The purpose of this study is to explore the safety climate perceptions of the multicultural nursing workforce, and to investigate the influence of diversity of the multicultural nursing workforce on clinical safety in a large tertiary hospital in Saudi Arabia. Background Working in a multicultural environment is challenging. Each culture has its own unique characteristics and dimensions that shape the language, lifestyle, beliefs, values, customs, traditions, and patterns of behaviour, which expatriate nurses must come to terms with. However, cultural diversity in the health care environment can potentially affect the quality of care and patient safety. Method A mixed-method case study (survey, interview and document analysis) was employed. A primary study phase entailed the administration of the Safety Climate Survey (SCS). A population sampling strategy was used and 319 nurses participated, yielding a 76.8% response rate. Descriptive and inferential statistics (Kruskal–Wallis test) were used to analyse survey data. Results The data revealed the nurses’ perceptions of the clinical safety climate in this multicultural environment was unsafe, with a mean score of 3.9 out of 5. No significant difference was found between the age groups, years of nursing experience and their perceptions of the safety climate in this context. A significant difference was observed between the national background categories of nurses and perceptions of safety climate. Conclusion Cultural diversity within the nursing workforce could have a significant influence on perceptions of clinical safety. These findings have the potential to inform policy and practice related to cultural diversity in Saudi Arabia.

Representation of assertions in clinical free-­text using SNOMED CT

Information retrieval (IR) by clinicians in the healthcare setting is critical for informing clinical decision-making. However, a large part of this information is in the form of free-text and inhibits clinical decision support and effective healthcare services. This makes meaningful use of clinical free-­text in electronic health records (EHRs) for patient care a difficult task. Within the context of IR, given a repository of free-­text clinical reports, one might want to retrieve and analyse data for patients who have a known clinical finding.

Using ‘think aloud’ as a strategy for improving clinical reasoning in high fidelity case-based simulation for undergraduate nursing students.

Theme Paper for Curriculum innovation and enhancement theme AIM: This paper reports on a research project that trialled an educational strategy implemented in an undergraduate nursing curriculum. The project aimed to explore the effectiveness of ‘think aloud’ as a strategy for improving clinical reasoning for students in simulated clinical settings. BACKGROUND: Nurses are required to apply and utilise critical thinking skills to enable clinical reasoning and problem solving in the clinical setting (Lasater, 2007). Nursing students are expected to develop and display clinical reasoning skills in practice, but may struggle articulating reasons behind decisions about patient care. The ‘think aloud’ approach is an innovative learning/teaching method which can create an environment suitable for developing clinical reasoning skills in students (Banning, 2008, Lee and Ryan-Wenger, 1997). This project used the ‘think aloud’ strategy within a simulation context to provide a safe learning environment in which third year students were assisted to uncover cognitive approaches to assist in making effective patient care decisions, and improve their confidence, clinical reasoning and active critical reflection about their practice. MEHODS: In semester 2 2011 at QUT, third year nursing students undertook high fidelity simulation (some for the first time), commencing in September of 2011. There were two cohorts for strategy implementation (group 1= used think aloud as a strategy within the simulation, group 2= no specific strategy outside of nursing assessment frameworks used by all students) in relation to problem solving patient needs. The think aloud strategy was described to students in their pre-simulation briefing and allowed time for clarification of this strategy. All other aspects of the simulations remained the same, (resources, suggested nursing assessment frameworks, simulation session duration, size of simulation teams, preparatory materials). Ethics approval has been obtained for this project. RESULTS: Results of a qualitative analysis (in progress- will be completed by March 2012) of student and facilitator reports on students’ ability to meet the learning objectives of solving patient problems using clinical reasoning and experience with the ‘think aloud’ method will be presented. A comparison of clinical reasoning learning outcomes between the two groups will determine the effect on clinical reasoning for students responding to patient problems. CONCLUSIONS: In an environment of increasingly constrained clinical placement opportunities, exploration of alternate strategies to improve critical thinking skills and develop clinical reasoning and problem solving for nursing students is imperative in preparing nurses to respond to changing patient needs.

Negotiating teacher identities : dialogic reflections on classroom interaction in a transnational context

This study investigates the development of teacher identity in a transnational context through an analysis of the voices of sixteen preservice teachers from Hong Kong who engage in interaction with primary students in an Australian classroom. The context for this research is the school-based experience undertaken by these preservice English as a second language teachers as part of their short language immersion (SLIM) program in Brisbane, Australia. Such SLIM programs are a genre of study abroad programs which have been gaining in popularity within teacher education in Australia, attended by preservice and inservice teachers from China, Hong Kong, Korea, and other Asian countries. This research is conducted at a time when the imperative to globalise higher education provision is a strategic factor in the educational policies of both Australia and Hong Kong. In Australia, international educational services now constitute the country’s third largest export with more than 400,000 students coming to Australia to study annually. In order to maintain Australia’s current global position as the third most popular Englishspeaking study destination, the government is now focusing on sustainability and the quality of the study experience being offered to international students (Bradley Review, 2008). In Hong Kong, the government sponsors both preservice and inservice English as a second language (ESL) teachers to undertake SLIM programs in Australia and other English-speaking countries, as part of their policy of promoting high levels of English proficiency in Hong Kong classrooms. Transnational teacher education is an important issue to which this study contributes insights into the affordances and constraints of a school-based experience in the transnational context. Second language teacher education has been defined as interventions designed to develop participants’ professional knowledge. In this study, it is argued that participation in a different community of practice helps to foreground tacit theories of second language pedagogy, making them visible and open to review. Questions of pedagogy are also seen as questions of teacher identity, constituting the way that one is in the classroom. I take up a sociocultural and poststructural framework, drawing on the work of James Gee and Mikhail Bakhtin, to theorise the construction of teacher identity as emerging through dialogic relations and socially situated discursive practices. From this perspective, this study investigates whether these teachers engage with different ways of representing themselves through appropriating, adapting or rejecting Discourses prevailing in the Australian classroom. Research suggests that reflecting on dilemmas encountered as lived experiences can extend professional understandings. In this study, the participants engage in a process of dialogic reflection on their intercultural classroom interactions, examining with their peers and their lecturer/researcher selected moments of dissonance that they have faced in the unfamiliar context of an Australian primary classroom. It is argued that the recursive and multivoiced nature of this process of reflection on practice allows participants opportunities to negotiate new understandings of second language teacher identity. Dialogic learning, based on the theories of Bakhtin and Vygotsky, provides the theoretic framing not only for the process of reflection instantiated in this study, but also features in the analysis of the participants’ second language classroom practices. The research design uses a combined discourse analytic and ethnographic approach as a logic-of-inquiry to explore the dialogic relationships which these second language teachers negotiate with their students and their peers in the transnational context. In this way, through discourse analysis of their classroom talk and reflective dialogues, assisted by the analytic tools of speech genres and discourse formats, I explore the participants’ ways of doing and being second language teachers. Thus, this analysis traces the process of ideological becoming of these beginner teachers as shifts in their understandings of teacher and student identities. This study also demonstrates the potential for a nontraditional stimulated recall interview to provide dialogic scaffolding for beginner teachers to reflect productively on their practice.

English language teacher education in Cuba : context, pedagogy and identity

In this study, I investigate the model of English language teacher education developed in Cuba. It includes features that would be considered innovative, contemporary, good practice anywhere in the Western world, as well as having distinctly Cuban elements. English is widely taught in Cuba in the education system and on television by Cuban teachers who are prepared in five-year courses at pedagogical universities by bilingual Cuban teacher educators. This case study explores the identity and pedagogy of six English language teacher educators at Cuba’s largest university of pedagogical sciences. Postcolonial theory provides a framework for examining how the Cuban pedagogy of English language teacher education resists the negative representation of Cuba in hegemonic Western discourse; and challenges neoliberal Western dogma. Postcolonial concepts of representation, resistance and hybridity are used in this examination. Cuban teacher education features a distinctive ‘pedagogy of tenderness’. Teacher educators build on caring relationships and institutionalised values of solidarity, collectivism and collaboration. Communicative English language teaching strategies are contextualised to enhance the pedagogical and communicative competence of student teachers, and intercultural intelligibility is emphasised. The collaborative pedagogy of Cuban English language teacher education features peer observation, mentoring and continuing professional development; as well as extensive pre-service classroom teaching and research skill development for student teachers. Being Cuban and bilingual are significant aspects of the professional identity of case members, who regard their profession as a vocation and who are committed to preparing good English language teachers.

Suspected mechanisms in the cause of overuse running injuries : A clinical review

Context: Various epidemiological studies have estimated that up to 70% of runners sustain an overuse running injury each year. Although few overuse running injuries have an established cause, more than 80% of running-related injuries occur at or below the knee, which suggests that some common mechanisms may be at work. The question then becomes, are there common mechanisms related to overuse running injuries? Evidence Acquisition: Research studies were identified via the following electronic databases: MEDLINE, EMBASE PsycInfo, and CINAHL (1980–July 2008). Inclusion was based on evaluation of risk factors for overuse running injuries. Results: A majority of the risk factors that have been researched over the past few years can be generally categorized into 2 groups: atypical foot pronation mechanics and inadequate hip muscle stabilization. Conclusion: Based on the review of literature, there is no definitive link between atypical foot mechanics and running injury mechanisms. The lack of normative data and a definition of typical foot structure has hampered progress. In contrast, a large and growing body of literature suggests that weakness of hip-stabilizing muscles leads to atypical lower extremity mechanics and increased forces within the lower extremity while running.

Intercultural dance : exploring a Finnish migrant connection with indigenous cultures through dance

This research is a dance-based, autoethnographic study which explores my connection with place as a Savolainen woman born on Kalkadoon country; an Australian-born Finn. Edward Relph states 'the more profoundly inside a place the person feels, the stronger will be his or her identity with that place' (1976, 49). I am interested in how a sense of "place identity" has informed my choreographic practice. Autoethnography is important because it places the research within a lived experience: my insider account of a lived experience within the White Australia Policy through my lens as a first generation Australian-born Finn. It also speaks to the space in-between for those, like me, who feel they do not fit into mainstream identity but look like they do. By exploring my lived experience through dance autoethnography, new understandings of my place identity within a cultural, social and political context have emerged. Ellis and Flaherty state ‘subjectivity is situated such that the voices in our heads and the feelings in our bodies are linked to political, cultural, and historical contexts’ (1992, 4). In order to begin my rehearsal process, I wanted a cultural framework which related to connection with land to guide the research. My investigations led me to the Maori examples of "Tikanga Maori" (Tikanga are the customs and traditions), in particular the "Pepeha" (Introduction) and allowed me to challenge my choreographic practice through this cultural framework.

Development and use of risk adjusted statistical process control tools for the monitoring and improvement of clinical outcomes in interventional cardiology

This thesis explored the development of statistical methods to support the monitoring and improvement in quality of treatment delivered to patients undergoing coronary angioplasty procedures. To achieve this goal, a suite of outcome measures was identified to characterise performance of the service, statistical tools were developed to monitor the various indicators and measures to strengthen governance processes were implemented and validated. Although this work focused on pursuit of these aims in the context of a an angioplasty service located at a single clinical site, development of the tools and techniques was undertaken mindful of the potential application to other clinical specialties and a wider, potentially national, scope.

Let's eat the captain! Thinking, feeling, doing : intercultural language learning through process drama

This research investigated the sustained use of process drama in a middle school foreign language classroom. The experience led to widespread learner engagement, a deeper contextualisation of the language as a socio-cultural practice, and a willingness to use the spoken and written language, regardless of limited proficiency. The drama required that language use be context and culture specific, contingent and multi-modal, which encouraged the beginner students to "mushfake" or improvise spoken and written text. Particularly important was the way the body was used through drama to express emotion, remember language and to illustrate the sociocultural context of its use.

Relational regulation theory and the role of social support and organisational fairness for nurses in a general acute context

Aims and objectives. To present a novel approach to nurse stress by exploring the demand–control–support model with organisational justice through the lens of relational regulation theory. Background. Nursing is often stressful due to high demands and dissatisfaction with pay, which impacts the mental well-being and productivity of nurses. Design. A cross-sectional design. Methods. A validated questionnaire was sent to the work addresses of all nursing and midwifery staff in a medium-sized general acute hospital in Australia. A total of 190 nurses and midwives returned completed questionnaires for the analyses. Results. The multiple regression analyses demonstrated that the model applies to the prototypical context of a general acute hospital and that job control, supervisor support and outside work support improve the job satisfaction and mental health of nurses. Conclusions. Most importantly, supervisor support was found to buffer the impact of excessive work demands. Fairness of procedures, distribution of resources and the quality and consistency of information are also beneficial. Relational regulation theory is applied to these findings as a novel way to conceptualise the mechanisms of support and fairness in nursing. Relevance to clinical practice. The importance of nurses’ well-being and job satisfaction is a priority for improving clinical outcomes. Practically, this means nurse managers should be encouraging nurses in the pursuit of diverse relational activities both at work and outside work.

Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma : clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study

Background The effects of extra-pleural pneumonectomy (EPP) on survival and quality of life in patients with malignant pleural mesothelioma have, to our knowledge, not been assessed in a randomised trial. We aimed to assess the clinical outcomes of patients who were randomly assigned to EPP or no EPP in the context of trimodal therapy in the Mesothelioma and Radical Surgery (MARS) feasibility study. Methods MARS was a multicentre randomised controlled trial in 12 UK hospitals. Patients aged 18 years or older who had pathologically confirmed mesothelioma and were deemed fit enough to undergo trimodal therapy were included. In a prerandomisation registration phase, all patients underwent induction platinum-based chemotherapy followed by clinical review. After further consent, patients were randomly assigned (1:1) to EPP followed by postoperative hemithorax irradiation or to no EPP. Randomisation was done centrally with computer-generated permuted blocks stratified by surgical centre. The main endpoints were feasibility of randomly assigning 50 patients in 1 year (results detailed in another report), proportion randomised who received treatment, proportion eligible (registered) who proceeded to randomisation, perioperative mortality, and quality of life. Patients and investigators were not masked to treatment allocation. This is the principal report of the MARS study; all patients have been recruited. Analyses were by intention to treat. This trial is registered, number ISRCTN95583524. Findings Between Oct 1, 2005, and Nov 3, 2008, 112 patients were registered and 50 were subsequently randomly assigned: 24 to EPP and 26 to no EPP. The main reasons for not proceeding to randomisation were disease progression (33 patients), inoperability (five patients), and patient choice (19 patients). EPP was completed satisfactorily in 16 of 24 patients assigned to EPP; in five patients EPP was not started and in three patients it was abandoned. Two patients in the EPP group died within 30 days and a further patient died without leaving hospital. One patient in the no EPP group died perioperatively after receiving EPP off trial in a non-MARS centre. The hazard ratio [HR] for overall survival between the EPP and no EPP groups was 1·90 (95% CI 0·92-3·93; exact p=0·082), and after adjustment for sex, histological subtype, stage, and age at randomisation the HR was 2·75 (1·21-6·26; p=0·016). Median survival was 14·4 months (5·3-18·7) for the EPP group and 19·5 months (13·4 to time not yet reached) for the no EPP group. Of the 49 randomly assigned patients who consented to quality of life assessment (EPP n=23; no EPP n=26), 12 patients in the EPP group and 19 in the no EPP group completed the quality of life questionnaires. Although median quality of life scores were lower in the EPP group than the no EPP group, no significant differences between groups were reported in the quality of life analyses. There were ten serious adverse events reported in the EPP group and two in the no EPP group. Interpretation In view of the high morbidity associated with EPP in this trial and in other non-randomised studies a larger study is not feasible. These data, although limited, suggest that radical surgery in the form of EPP within trimodal therapy offers no benefit and possibly harms patients. Funding Cancer Research UK (CRUK/04/003), the June Hancock Mesothelioma Research Fund, and Guy's and St Thomas' NHS Foundation Trust. © 2011 Elsevier Ltd.

Putting vital stains in context

While vital staining remains a cornerstone in the diagnosis of ocular disease and contact lens complications, there are many misconceptions regarding the properties of commonly used dyes by eye-care practitioners and what is and what is not corneal staining after instillation of sodium fluorescein. Similarly, the proper use and diagnostic utility of rose Bengal and lissamine green B, the other two ophthalmic dyes commonly used for assessing ocular complications, have similarly remained unclear. Due to the limitations of vital stains for definitive diagnosis, concomitant signs and symptoms in addition to a complete patient history are required. Over the past decade, there have been many reports of a type of corneal staining—often referred to as solution-induced corneal staining (SICS)—that is observed with the use of multipurpose solutions in combination with soft lenses, more specifically silicone hydrogel lenses. Some authors believe that SICS is a sign of lens/solution incompatibility; however, new research shows that SICS may be neither a measure of lens/solution biocompatibility nor ‘true’ corneal staining, as that observed in pathological situations. A large component of SICS may be a benign phenomenon, known as preservative-associated transient hyperfluorescence (PATH). There is a lack of correlated signs and/or symptoms with SICS/PATH. Several properties of SICS/PATH, such as appearance and duration, differentiate it from pathological corneal staining. This paper reviews the properties of vital stains, their use and limitations in assessment of the ocular surface, the aetiology of corneal staining, characteristics of SICS/PATH that differentiate it from pathological corneal staining and what the SICS/PATH phenomenon means for contact lens-wearing patients.

Response to re : putting vital stains in context

A response to: "Re: Putting vital stains in context" by Eric Papas & Lyndon Jones, published in the same issue of this journal. "There has been considerable discussion in recent times about the origins of solution-induced corneal staining (SICS) and I welcome this opportunity to further clarify some points raised in my paper1 in relation to certain issues highlighted by Drs Papas and Jones.2 Part of the difficulty in understanding these phenomena relates to the imprecise terminology used. For example, Drs Papas and Jones state ‘. . . SICS..."

Response to re : putting vital stains in context

A response to "Re: Putting vital stains in context" by Charles W McMonnies, published in the same issue of this journal. "I thank Professor McMonnies for his thoughtful comments,1 which rightly forcemeto more directly address the clinical ramifications of solution-induced corneal staining (SICS). I concur with his observation that determining whether the staining can be attributed to preservative-associated transient hyperfluorescence (PATH) or true pathology can be difficult in a typical clinical situation, perhaps requiring two visits in a single day. There is no easy answer to this dilemma..."