The ontological deficiencies of process modeling in practice

Business process modeling is widely regarded as one of the most popular forms of conceptual modeling. However, little is known about the capabilities and deficiencies of process modeling grammars and how existing deficiencies impact actual process modeling practice. This paper is a first contribution towards a theory-driven, exploratory empirical investigation of the ontological deficiencies of process modeling with the industry standard Business Process Modeling Notation (BPMN). We perform an analysis of BPMN using a theory of ontological expressiveness. Through a series of semi-structured interviews with BPMN adopters we explore empirically the actual use of this grammar. Nine ontological deficiencies related to the practice of modeling with BPMN are identified, for example, the capture of business rules and the specification of process decompositions. We also uncover five contextual factors that impact on the use of process modeling grammars, such as tool support and modeling conventions. We discuss implications for research and practice, highlighting the need for consideration of representational issues and contextual factors in decisions relating to BPMN adoption in organizations.

Building a methodology for context-aware business processes: insights from an exploratory case study

This paper describes the findings derived from an exploratory case study into the business processes at a leading Australian insurance provider. The business processes are frequently subjected to changes and deviations due to contextual events such as weather, financial conditions and others. In this study, we examine how context impacts business processes and how resulting business process changes are enacted. From our analysis, we suggest a methodological framework to guide organisations in the complex challenge of linking changing contextual factors with internal process design.

Framework for assessing financial literacy and superannuation investment choice decisions

There is a worldwide trend towards rapidly growing defined contribution pension funds in terms of assets and membership, and the choices available to individuals. This has shifted the decisionmaking responsibility to fund members for managing the investment of their retirement savings. This change has given rise to a phenomenon where most superannuation fund members are responsible for either actively choosing or passively relying on their funds’ default investment options. Prior research identifies that deficiencies in financial literacy is one of the causes of inertia in financial decision-making and findings from international and Australian studies show that financial illiteracy is wide-spread. Given the potential significant economic and social consequences of poor financial decision-making in superannuation matters, this paper proposes a framework by which the various demographic, social and contextual factors that influence fund members’ financial literacy and its association with investment choice decisions are explored. Enhanced theoretical and empirical understanding of the factors that are associated with active/passive investment choice decisions would enable development of well-targeted financial education programs.

Response : letter to the editor by Al-Azri and Al-Maniri

Firstly, the authors would like to thank the editor for the opportunity to respond to Dr Al-Azri’s and Dr Al-Maniri’s letter. Secondly, while the current authors also accept that deterrence-based approaches should act as only one corner-stone of a suite of interventions and public policy initiatives designed to improve road safety, deterrence-based approaches have nonetheless consistently proven to be a valuable resource to improve road safety. Dr Al-Azri and Dr Al-Maniri reinforce their assertion about the limited utility of deterrence by citing drink driving research, and the issue of drink driving is particularly relevant within the current context given that the problem of driving after drinking has historically been addressed through deterrence-based approaches. While the effectiveness of deterrence-based approaches to reduce drink driving will always be dependent upon a range of situational and contextual factors (including police enforcement practices, cultural norms, etc), the utilisation of this approach has proven particularly effective within Queensland, Australia. For example, a relatively recent comprehensive review of Random Breath Testing in Queensland demonstrated that this initiative not only had a deterrent impact upon self-reported intentions to drink and drive, but was also found to have significantly reduced alcohol-related fatalities in the state. However, the authors agree that deterrence-based approaches can be particularly transient and thus require constant “topping up” not least through sustained public reinforcement, which was clearly articulated in the seminal work by Homel.

Assessment policy change in relation to English language teaching and learning in China : a study of perspectives from two universities

In response to concerns about the quality of English Language Learning (ELL) education at tertiary level, the Chinese Ministry of Education (CMoE) launched the College English Reform Program (CERP) in 2004. By means of a press release (CMoE, 2005) and a guideline document titled College English Curriculum Requirements (CECR) (CMoE, 2007), the CERP proposed two major changes to the College English assessment policy, which were: (1) the shift to optional status for the compulsory external test, the College English Test Band 4 (CET4); and (2) the incorporation of formative assessment into the existing summative assessment framework. This study investigated the interactions between the College English assessment policy change, the theoretical underpinnings, and the assessment practices within two Chinese universities (one Key University and one Non-Key University). It adopted a sociocultural theoretical perspective to examine the implementation process as experienced by local actors of institutional and classroom levels. Systematic data analysis using a constant comparative method (Merriam, 1998) revealed that contextual factors and implementation issues did not lead to significant differences in the two cases. Lack of training in assessment and the sociocultural factors such as the traditional emphasis on the product of learning and hierarchical teacher/students relationship are decisive and responsible for the limited effect of the reform.

The morphology of service bundling settings

The purpose of this paper is to advance our understanding of what contextual factors influence the service bundling process in an organizational setting. Although previous literature contains insights into the mechanisms underlying bundling and the artefacts for performing the bundling task itself, the body of knowledge seems to lack a comprehensive framework for analysing the actual scenario in which the bundling process is performed. This is required as the scenario will influence the bundling method and the IT support. We address this need by designing a morphological box for analysing bundling scenarios in different organizational settings. The factors featured in the box are systematised into a set of four categories of bundling layers which we identify from reviewing literature. The two core layers in the framework are the service bundling on a type level and on an instance level (i.e. configuration). To demonstrate the applicability and utility of the proposed morphological box, we apply it to assess the underlying differences and commonalities of two different bundling scenarios from the B2B and G2C sectors which stress the differences between bundling on a type and instance level. In addition, we identify several prospects for future research that can benefit from the proposed morphological box.

Planning for literacy learning

Effective planning is an important part of meeting the learning needs of students in middle years classrooms. Yet this is a task with inherent complexity. Teachers who subscribe to a contemporary philosophy of middle years education often come together to cooperatively plan and teach a major project. These teachers often represent a range of teaching areas and between them they work with groups of students. Working in this way requires teachers to juggle the demands of curriculum, pedagogy and assessment, while considering short and long term goals and objectives, the diverse needs of students, and relevant contextual factors. Because all teachers, regardless of their specialist teaching area, are teachers of literacy, expertise in planning for content learning as well as literacy learning is essential.

The role of organisational culture, trust and mechanisms in inter-project knowledge sharing

Knowledge has been recognised as a powerful yet intangible asset, which is difficult to manage. This is especially true in a project environment where there is the potential to repeat mistakes, rather than learn from previous experiences. The literature in the project management field has recognised the importance of knowledge sharing (KS) within and between projects. However, studies in that field focus primarily on KS mechanisms including lessons learned (LL) and post project reviews as the source of knowledge for future projects, and only some preliminary research has been carried out on the aspects of project management offices (PMOs) and organisational culture (OC) in KS. This study undertook to investigate KS behaviours in an inter-project context, with a particular emphasis on the role of trust, OC and a range of knowledge sharing mechanisms (KSM) in achieving successful inter-project knowledge sharing (I-PKS). An extensive literature search resulted in the development of an I-PKS Framework, which defined the scope of the research and shaped its initial design. The literature review indicated that existing research relating to the three factors of OC, trust and KSM remains inadequate in its ability to fully explain the role of these contextual factors. In particular, the literature review identified these areas of interest: (1) the conflicting answers to some of the major questions related to KSM, (2) the limited empirical research on the role of different trust dimensions, (3) limited empirical evidence of the role of OC in KS, and (4) the insufficient research on KS in an inter-project context. The resulting Framework comprised the three main factors including: OC, trust and KSM, demonstrating a more integrated view of KS in the inter-project context. Accordingly, the aim of this research was to examine the relationships between these three factors and KS by investigating behaviours related to KS from the project managers‘ (PMs‘) perspective. In order to achieve the aim, this research sought to answer the following research questions: 1. How does organisational culture influence inter-project knowledge sharing? 2. How does the existence of three forms of trust — (i) ability, (ii) benevolence and (iii) integrity — influence inter-project knowledge sharing? 3. How can different knowledge sharing mechanisms (relational, project management tools and process, and technology) improve inter-project knowledge sharing behaviours? 4. How do the relationships between these three factors of organisational culture, trust and knowledge sharing mechanisms improve inter-project knowledge sharing? a. What are the relationships between the factors? b. What is the best fit for given cases to ensure more effective inter-project knowledge sharing? Using multiple case studies, this research was designed to build propositions emerging from cross-case data analysis. The four cases were chosen on the basis of theoretical sampling. All cases were large project-based organisations (PBOs), with a strong matrix-type structure, as per the typology proposed by the Project Management Body of Knowledge (PMBoK) (2008). Data were collected from project management departments of the respective organisations. A range of analytical techniques were used to deal with the data including pattern matching logic and explanation building analysis, complemented by the use of NVivo for data coding and management. Propositions generated at the end of the analyses were further compared with the extant literature, and practical implications based on the data and literature were suggested in order to improve I-PKS. Findings from this research conclude that OC, trust, and KSM contribute to inter-project knowledge sharing, and suggest the existence of relationships between these factors. In view of that, this research identified the relationships between different trust dimensions, suggesting that integrity trust reinforces the relationship between ability trust and knowledge sharing. Furthermore, this research demonstrated that characteristics of culture and trust interact to reinforce preferences for mechanisms of knowledge sharing. This means that cultures that facilitate characteristics of Clan type are more likely to result in trusting relationships, hence are more likely to use organic sources of knowledge for both tacit and explicit knowledge exchange. In contrast, cultures that are empirically driven, based on control, efficiency, and measures (characteristics of Hierarchy and Market types) display tendency to develop trust primarily in ability of non-organic sources, and therefore use these sources to share mainly explicit knowledge. This thesis contributes to the project management literature by providing a more integrative view of I-PKS, bringing the factors of OC, trust and KSM into the picture. A further contribution is related to the use of collaborative tools as a substitute for static LL databases and as a facilitator for tacit KS between geographically dispersed projects. This research adds to the literature on OC by providing rich empirical evidence of the relationships between OC and the willingness to share knowledge, and by providing empirical evidence that OC has an effect on trust; in doing so this research extends the theoretical propositions outlined by previous research. This study also extends the research on trust by identifying the relationships between different trust dimensions, suggesting that integrity trust reinforces the relationship between ability trust and KS. Finally, this research provides some directions for future studies.

Principals’ and teacher leaders’ perceptions of their role and interaction under current Chinese reform : a case study in Shandong province

This study aims to explore the perceptions of principals and teacher leaders regarding their roles and the interaction between these roles in Chinese urban primary schools at the time of unprecedented curriculum reform. This involves a complexity of factors such as the influence of globalisation, the impact of traditional Chinese cultural attitudes towards education through Confucianism, and the implementation requirements of the current education reforms. All of these wider contextual factors help to shape the leadership practices that are described in the study. A qualitative exploratory case study approach has been utilised to undertake this investigation. The conceptual framework for this study draws upon scholars‘ work from Western countries but has been adapted in order to address three research questions for the study‘s focus on the context in Shandong province, Mainland China. Three research questions were addressed: First, what are principals‘ perceptions of their leadership roles in Mainland China under current educational reform? Second, what are teacher leaders‘ perceptions of their leadership roles in Mainland China under current educational reform? And finally, what are principals‘ and teacher leaders‘ perceptions of how their roles interact? With reference to the principals in the study, the findings confirm Gurr‘s (2008) comprehensive leadership model relating to four roles, specifically, learning and teaching, symbolic and cultural awareness, future orientation, and accountability. Significantly, some sub-roles that emerge from the data are uniquely Chinese. For example, school culture construction is a very deliberate process in which principals and their staff talked openly about and were involved in creating a positive school climate comprising spiritual, material, and system dimensions. Another finding relates to school feature construction. This refers to the process that principals and staff used to make their schools distinctive and different from other schools and included such features as the school‘s philosophy and the school-based curriculum. In seeking to understand the nature of teacher leadership in Chinese primary schools, this research confirms some findings identified in Western literature. For instance, teacher leaders in Shandong province were involved in decision-making, working with parents and community members, undertaking and planning professional development for staff, and mediating between colleagues (Day & Harris, 2002; Harrison & Killion, 2007; Leithwood, Jantzi, & Steinbach, 1999; Muijs & Harris, 2006; Smylie, 1992). However, some new aspects, such as a heightened awareness of the importance of accountability, emerge from this study. The study‘s conceptual framework also draws upon some significant insights from micropolitics and, in particular, two core constructs, namely cooperation and conflict (Blase, 1991), to explore the interactions between principals and teacher leaders. In this study, principals and teacher leaders employed exchange and facilitation as two strategies in cooperative processes; and they adopted enforcement and compromise in conflictive processes. Finally, the study‘s findings indicate that principals and teacher leaders were developing new ways of interacting in response to the requirements of significant education reform. Most principals were exercising their power through (Blase, 1991) their teacher leaders who in turn, were working in alignment with their principals to achieve the desired outcomes in schools. It was significant that this form of 'parallel leadership' (Crowther, Ferguson, & Ham, 2009) characterised the teacher leadership roles at this period of change to the curriculum in Mainland China.

Explaining Gendered Sentencing Patterns for Men and Women in the Late Victorian Period

Contemporary studies of disparities in the sentencing of male and female offenders claim that the differences found are caused by gender-related contextual factors, but not by a gender bias. In contrast, historical studies have suggested that women were disadvantaged by appearing to offend both against the law and the conventions of femininity. This article analyses minor assaults prosecuted in ten English magistrates’ courts between 1880 and 1920. It is based on a data-set that combines court cases and newspaper reports, and allows for the control of gender differences in sentencing outcomes through four contextual factors: severity of the assault, bonds between victim and assailant, culpability, and evidence. The findings reveal a differentiated pattern of sentences that questions the assumption that ‘doubly deviant’ women were more often convicted, and received higher penalties, throughout the Victorian period. The results show that the contextual factors of the offence affected judicial decision-making to the extent that they virtually account for gender differences in conviction rates, but do not, on their own, account for the different penalties handed out to men and women. Women who committed similar assaults to men were likely to receive a lighter punishment. Magistrates clearly targeted ‘male’ contexts of violence, and handed down more convictions and harsher penalties to men involved in these, in contrast to women involved in 'female' contexts. The findings of a strong gender bias in sentencing that disadvantaged lowerclass men indicate that local magistrates directed their efforts of 'civilizing' lower-class communities at 'dangerous masculinities', and deemed assaults committed by women as less important in this task.

Media classification : Content regulation in an age of convergent media

This article outlines the key recommendations of the Australian Law Reform Commission’s review of the National Classification Scheme, as outlined in its report Classification – Content Regulation and Convergent Media (ALRC, 2012). It identifies key contextual factors that underpin the need for reform of media classification laws and policies, including the fragmentation of regulatory responsibilities and the convergence of media platforms, content and services, as well as discussing the ALRC’s approach to law reform.

Quantitative approaches to comparing communication patterns on Twitter

To date, the available literature mainly discusses Twitter activity patterns in the context of individual case studies, while comparative research on a large number of communicative events and their dynamics and patterns is missing. By conducting a comparative study of more than 40 different cases (covering topics such as elections, natural disasters, corporate crises, and televised events) we identify a number of distinct types of discussion that can be observed on Twitter. Drawing on a range of communicative metrics, we show that thematic and contextual factors influence the usage of different communicative tools available to Twitter users, such as original tweets, @replies, retweets, and URLs. Based on this first analysis of the overall metrics of Twitter discussions, we also demonstrate stable patterns in the use of Twitter in the context of major topics and events.

Thinking about Australia and its location in the modern world in the Australian Curriculum : history

The first national history curriculum is being implemented in Australia from 2013. As with the curriculums of other nations, this curriculum has evolved in response to a range of factors and its merits continue to be debated. In critiquing the sort of history education approach encapsulated in the new curriculum, I discuss some of the contextual factors and debates that have shaped the Australian Curriculum: History v0.3 (ACARA, 2012). In doing so, I also explore some of the recent international literature on how students think and learn about history in the classroom. In the third and final part of the paper, I raise some logistical issues and also question how students might engage with the notion of Australia as a nation in the modern world rapidly reshaped by the transformations occurring in Asia and share some concerns about the curriculum’s ‘world history approach’ for Year 10.

Identification and evaluation of service bundles for governmental one-stop portals

Recent advances in the area of ‘Transformational Government’ position the citizen at the centre of focus. This paradigm shift from a department-centric to a citizen-centric focus requires governments to re-think their approach to service delivery, thereby decreasing costs and increasing citizen satisfaction. The introduction of franchises as a virtual business layer between the departments and their citizens is intended to provide a solution. Franchises are structured to address the needs of citizens independent of internal departmental structures. For delivering services online, governments pursue the development of a One-Stop Portal, which structures information and services through those franchises. Thus, each franchise can be mapped to a specific service bundle, which groups together services that are deemed to be of relevance to a specific citizen need. This study focuses on the development and evaluation of these service bundles. In particular, two research questions guide the line of investigation of this study: Research Question 1): What methods can be used by governments to identify service bundles as part of governmental One-Stop Portals? Research Question 2): How can the quality of service bundles in governmental One-Stop Portals be evaluated? The first research question asks about the identification of suitable service bundle identification methods. A literature review was conducted, to, initially, conceptualise the service bundling task, in general. As a consequence, a 4-layer model of service bundling and a morphological box were created, detailing characteristics that are of relevance when identifying service bundles. Furthermore, a literature review of Decision-Support Systems was conducted to identify approaches of relevance in different bundling scenarios. These initial findings were complemented by targeted studies of multiple leading governments in the e-government domain, as well as with a local expert in the field. Here, the aim was to identify the current status of online service delivery and service bundling in practice. These findings led to the conceptualising of two service bundle identification methods, applicable in the context of Queensland Government: On the one hand, a provider-driven approach, based on service description languages, attributes, and relationships between services was conceptualised. As well, a citizen-driven approach, based on analysing the outcomes from content identification and grouping workshops with citizens, was also conceptualised. Both methods were then applied and evaluated in practice. The conceptualisation of the provider-driven method for service bundling required the initial specification of relevant attributes that could be used to identify similarities between services called relationships; these relationships then formed the basis for the identification of service bundles. This study conceptualised and defined seven relationships, namely ‘Co-location’, ‘Resource’, ‘Co-occurrence’, ‘Event’, ‘Consumer’, ‘Provider’, and ‘Type’. The relationships, and the bundling method itself, were applied and refined as part of six Action Research cycles in collaboration with the Queensland Government. The findings show that attributes and relationships can be used effectively as a means for bundle identification, if distinct decision rules are in place to prescribe how services are to be identified. For the conceptualisation of the citizen-driven method, insights from the case studies led to the decision to involve citizens, through card sorting activities. Based on an initial list of services, relevant for a certain franchise, participating citizens grouped services according to their liking. The card sorting activity, as well as the required analysis and aggregation of the individual card sorting results, was analysed in depth as part of this study. A framework was developed that can be used as a decision-support tool to assist with the decision of what card sorting analysis method should be utilised in a given scenario. The characteristic features associated with card sorting in a government context led to the decision to utilise statistical analysis approaches, such as cluster analysis and factor analysis, to aggregate card sorting results. The second research question asks how the quality of service bundles can be assessed. An extensive literature review was conducted focussing on bundle, portal, and e-service quality. It was found that different studies use different constructs, terminology, and units of analysis, which makes comparing these models a difficult task. As a direct result, a framework was conceptualised, that can be used to position past and future studies in this research domain. Complementing the literature review, interviews conducted as part of the case studies with leaders in e-government, indicated that, typically, satisfaction is evaluated for the overall portal once the portal is online, but quality tests are not conducted during the development phase. Consequently, a research model which appropriately defines perceived service bundle quality would need to be developed from scratch. Based on existing theory, such as Theory of Reasoned Action, Expectation Confirmation Theory, and Theory of Affordances, perceived service bundle quality was defined as an inferential belief. Perceived service bundle quality was positioned within the nomological net of services. Based on the literature analysis on quality, and on the subsequent work of a focus group, the hypothesised antecedents (descriptive beliefs) of the construct and the associated question items were defined and the research model conceptualised. The model was then tested, refined, and finally validated during six Action Research cycles. Results show no significant difference in higher quality or higher satisfaction among users for either the provider-driven method or for the citizen-driven method. The decision on which method to choose, it was found, should be based on contextual factors, such as objectives, resources, and the need for visibility. The constructs of the bundle quality model were examined. While the quality of bundles identified through the citizen-centric approach could be explained through the constructs ‘Navigation’, ‘Ease of Understanding’, and ‘Organisation’, bundles identified through the provider-driven approach could be explained solely through the constructs ‘Navigation’ and ‘Ease of Understanding’. An active labelling style for bundles, as part of the provider-driven Information Architecture, had a larger impact on ‘Quality’ than the topical labelling style used in the citizen-centric Information Architecture. However, ‘Organisation’, reflecting the internal, logical structure of the Information Architecture, was a significant factor impacting on ‘Quality’ only in the citizen-driven Information Architecture. Hence, it was concluded that active labelling can compensate for a lack of logical structure. Further studies are needed to further test this conjecture. Such studies may involve building alternative models and conducting additional empirical research (e.g. use of an active labelling style for the citizen-driven Information Architecture). This thesis contributes to the body of knowledge in several ways. Firstly, it presents an empirically validated model of the factors explaining and predicting a citizen’s perception of service bundle quality. Secondly, it provides two alternative methods that can be used by governments to identify service bundles in structuring the content of a One-Stop Portal. Thirdly, this thesis provides a detailed narrative to suggest how the recent paradigm shift in the public domain, towards a citizen-centric focus, can be pursued by governments; the research methodology followed by this study can serve as an exemplar for governments seeking to achieve a citizen-centric approach to service delivery.

Nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory : a mixed methods study

The cardiac catheterisation laboratory (CCL) is a specialised medical radiology facility where both chronic-stable and life-threatening cardiovascular illness is evaluated and treated. Although there are many potential sources of discomfort and distress associated with procedures performed in the CCL, a general anaesthetic is not usually required. For this reason, an anaesthetist is not routinely assigned to the CCL. Instead, to manage pain, discomfort and anxiety during the procedure, nurses administer a combination of sedative and analgesic medications according to direction from the cardiologist performing the procedure. This practice is referred to as nurse-administered procedural sedation and analgesia (PSA). While anecdotal evidence suggested that nurse-administered PSA was commonly used in the CCL, it was clear from the limited information available that current nurse-led PSA administration and monitoring practices varied and that there was contention around some aspects of practice including the type of medications that were suitable to be used and the depth of sedation that could be safely induced without an anaesthetist present. The overall aim of the program of research presented in this thesis was to establish an evidence base for nurse-led sedation practices in the CCL context. A sequential mixed methods design was used over three phases. The objective of the first phase was to appraise the existing evidence for nurse-administered PSA in the CCL. Two studies were conducted. The first study was an integrative review of empirical research studies and clinical practice guidelines focused on nurse-administered PSA in the CCL as well as in other similar procedural settings. This was the first review to systematically appraise the available evidence supporting the use of nurse-administered PSA in the CCL. A major finding was that, overall, nurse-administered PSA in the CCL was generally deemed to be safe. However, it was concluded from the analysis of the studies and the guidelines that were included in the review, that the management of sedation in the CCL was impacted by a variety of contextual factors including local hospital policy, workforce constraints and cardiologists’ preferences for the type of sedation used. The second study in the first phase was conducted to identify a sedation scale that could be used to monitor level of sedation during nurse-administered PSA in the CCL. It involved a structured literature review and psychometric analysis of scale properties. However, only one scale was found that was developed specifically for the CCL, which had not undergone psychometric testing. Several weaknesses were identified in its item structure. Other sedation scales that were identified were developed for the ICU. Although these scales have demonstrated validity and reliability in the ICU, weaknesses in their item structure precluded their use in the CCL. As findings indicated that no existing sedation scale should be applied to practice in the CCL, recommendations for the development and psychometric testing of a new sedation scale were developed. The objective of the second phase of the program of research was to explore current practice. Three studies were conducted in this phase using both quantitative and qualitative research methods. The first was a qualitative explorative study of nurses’ perceptions of the issues and challenges associated with nurse-administered PSA in the CCL. Major themes emerged from analysis of the qualitative data regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements. The second study in Phase Two was a cross-sectional survey of nurse-administered PSA practice in Australian and New Zealand CCLs. This was the first study to quantify the frequency that nurse-administered PSA was used in the CCL setting and to characterise associated nursing practices. It was found that nearly all CCLs utilise nurse-administered PSA (94%). Of note, by characterising nurse-administered PSA in Australian and New Zealand CCLs, several strategies to improve practice, such as setting up protocols for patient monitoring and establishing comprehensive PSA education for CCL nurses, were identified. The third study in Phase Two was a matched case-control study of risk factors for impaired respiratory function during nurse-administered PSA in the CCL setting. Patients with acute illness were found to be nearly twice as likely to experience impaired respiratory function during nurse-administered PSA (OR=1.78; 95%CI=1.19-2.67; p=0.005). These significant findings can now be used to inform prospective studies investigating the effectiveness of interventions for impaired respiratory function during nurse-administered PSA in the CCL. The objective of the third and final phase of the program of research was to develop recommendations for practice. To achieve this objective, a synthesis of findings from the previous phases of the program of research informed a modified Delphi study, which was conducted to develop a set of clinical practice guidelines for nurse-administered PSA in the CCL. The clinical practice guidelines that were developed set current best practice standards for pre-procedural patient assessment and risk screening practices as well as the intra and post-procedural patient monitoring practices that nurses who administer PSA in the CCL should undertake in order to deliver safe, evidence-based and consistent care to the many patients who undergo procedures in this setting. In summary, the mixed methods approach that was used clearly enabled the research objectives to be comprehensively addressed in an informed sequential manner, and, as a consequence, this thesis has generated a substantial amount of new knowledge to inform and support nurse-led sedation practice in the CCL context. However, a limitation of the research to note is that the comprehensive appraisal of the evidence conducted, combined with the guideline development process, highlighted that there were numerous deficiencies in the evidence base. As such, rather than being based on high-level evidence, many of the recommendations for practice were produced by consensus. For this reason, further research is required in order to ascertain which specific practices result in the most optimal patient and health service outcomes. Therefore, along with necessary guideline implementation and evaluation projects, post-doctoral research is planned to follow up on the research gaps identified, which are planned to form part of a continuing program of research in this field.