The role of comfort in child restraint use practices

Suboptimal restraint use, particularly the incorrect use of restraints, is a significant and widespread problem among child vehicle occupants, and increases the risk of injury. Previous research has identified comfort as a potential factor influencing suboptimal restraint use. Both the real comfort experienced by the child and the parent’s perception of the child’s comfort are reported to influence the optimal use of restraints. Problems with real comfort may lead the child to misuse the restraint in their attempt to achieve better comfort whilst parent-perceived discomfort has been reported as a driver for premature graduation and inappropriate restraint choice. However, this work has largely been qualitative. There has been no research that objectively studies either the association between real and parent-perceived comfort, or any association between comfort and suboptimal restraint use. One barrier to such studies is the absence of validated tools for quantifying real comfort in children. We aimed to develop methods to examine both real and parent-perceived comfort and examine their effects on suboptimal restraint use. We conducted online parent surveys (n=470) to explore what drives parental perceptions of their child’s comfort in restraint systems (study 1) and used data from field observation studies (n=497) to examine parent-perceived comfort and its relationship with observed restraint use (study 2). We developed methods to measure comfort in children in a laboratory setting (n=14) using video analysis to estimate a Discomfort Avoidance Behaviour (DAB) score, pressure mapping and adapted survey tools to differentiate between comfortable and induced discomfort conditions (study 3). The DAB rate was then used to compare an integrated booster with an add-on booster (study 4) Preliminary analysis of our recent online survey of Australian parents (study 1) indicates that 23% of parents report comfort as a consideration when making a decision to change restraints. Logistic regression modelling of data collected during the field observation study (study 2) revealed that parent-perceived discomfort was not significantly associated with premature graduation. Contrary to expectation, children of parents who reported that their child was comfortable were almost twice as likely to have been incorrectly restrained (p<0.01, 95% CI 1.24 - 2.77).In the laboratory study (study 3) we found our adapted survey tools did not provide a reliable measurement of real comfort among children. However our DAB score was able to differentiate between comfortable and induced discomfort conditions and correlated well with pressure mapping. Preliminary results from the laboratory comparison study (study 4) indicate a positive correlation between DAB rate and use errors. In experiments conducted to date, we have seen a significantly higher DAB rate in the integrated booster compared to the add-on booster (p < 0.01). However, this needs to be confirmed in a naturalistic setting and in further experiments that take length of time under observation into account. Our results suggest that while some parents report concern about their child’s comfort, parent-reported comfort levels were not associated with restraint choice. If comfort is important for optimal restraint use, it is likely to be the real comfort of the child rather than that reported by the parent. The method we have developed for studying real comfort can be used in naturalistic studies involving child occupants to further understand this relationship. This work will be of interest to vehicle and child restraint manufacturers interested in improving restraint design for young occupants as well as researchers and other stakeholders interested in reducing the incidence of restraint misuse among children.

Advancing practice in critical care : A model of knowledge integration: A Singaporean context

It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individuals practice progressing onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example practice development initiatives can be seen as advancing practice for the masses which ensures that practitioners are following the same level of practice. The question here is; are they developing individually. To discuss the potential development of a conceptual model of knowledge integration pertinent to critical care nursing practice. In an attempt to explore the development of leading edge critical care thinking and practice, a new model for advancing practice in critical care is proposed. This paper suggests that reflection may not be the best model for advancing practice unless the individual practitioner has a sound knowledge base both theoretically and experientially. Drawing on the contemporary literature and recent doctoral research, the knowledge integration model presented here uses multiple learning strategies that are focused in practise to develop practice, for example the use of work-based learning and clinical supervision. Ongoing knowledge acquisition and its relationship with previously held theory and experience will enable individual practitioners to advance their own practice as well as being a resource for others.

No Wrong Door: The Salvation Army Doorways Case Management Service

The primary aim of the evaluation project was to determine the impact of The Salvation Army Doorways case management model in relation to client satisfaction and meeting client needs. Specifically, the project sought to: • Provide an overview of structural barriers confronting individuals who are entrenched in enduring poverty; • Provide an overview of the specific issues encountered by individuals, including insight into personal challenges, hopes and dreams; • Analyse the effectiveness of Doorways interventions, specifically: o How important is the relationship with staff at the Doorways centre? o What skills and knowledge do staff need? o What Doorways activities are the most successful in breaking the cycle of poverty? o How important are community connections? • Provide information to The Salvation Army on what works well in Doorways and how Doorways might be improved or enhanced.

Current CAPE-15: A measure of recent psychotic-like experiences and associated distress

Aim Psychotic-like experiences (PLEs) are common in young people and are associated with both distress and adverse outcomes. The Community Assessment of Psychic Experiences-Positive Scale (CAPE-P) provides a 20-item measure of lifetime PLEs. A 15-item revision of this scale was recently published (CAPE-P15). Although the CAPE-P has been used to assess PLEs in the last 12 months, there is no version of the CAPE for assessing more recent PLEs (e.g. 3 months). This study aimed to determine the reliability and validity of the current CAPE-P15 and assess its relationship with current distress. Method A cross-sectional online survey of 489 university students (17–25 years) assessed lifetime and current substance use, current distress, and lifetime and 3-month PLEs on the CAPE-P15. Results Confirmatory factor analysis indicated that the current CAPE-P15 retained the same three-factor structure as the lifetime version consisting of persecutory ideation, bizarre experiences and perceptual abnormalities. The total score of the current version was lower than the lifetime version, but the two were strongly correlated (r = .64). The current version was highly predictive of generalized distress (r = .52) and indices that combined symptom frequency with associated distress did not confer greater predictive power than frequency alone. Conclusion This study provided preliminary data that the current CAPE-P15 provides a valid and reliable measure of current PLEs. The current CAPE-P15 is likely to have substantial practical utility if it is later shown to be sensitive to change, especially in prevention and early intervention for mental disorders in young people.

Swimming against the tide? Australian labour regulation and the fissured workplace

In The Fissured Workplace, David Weil dissects the ways in which ostensibly ‘large’ American businesses have come to shed direct employees and instead source their labour needs through a ‘complicated network of smaller business units’. As he notes, this has increased the profitability of these ‘lead’ businesses, at the expense of those who (ultimately) work for them: Wage setting and supervision shift from core businesses to a myriad of organizations, each operating under the rigorous standards of lead businesses but facing fierce competitive pressures. Although lead businesses set demanding goals and standards, and often detailed work practice requirements for subsidiary companies, the actual liability, oversight, and supervision of the workforce become the problem of one or more other organizations. And by replacing a direct employment relationship with a fissured workplace, employment itself becomes more precarious, with risk shifted onto smaller employers and individual workers, who are often cast in the role of independent businesses in their own right.

Emotional intelligence development in student radiation therapists: A longitudinal pilot study

Emotional intelligence (EI) is defined as “the ability to recognise, understand and manage emotions in ourselves and others” [1]. Initially identified as a concept applied to leadership and management, EI is now recognised as an important skill in a number of areas, including healthcare [2]. Empathy (the ability to see the world through someone else’s eyes) is known to play an important role in the therapeutic relationship with patients [3]. As EI has been shown to improve empathy [4], it is clear that developing the EI of student health professionals should benefit patients in the long term. It is not surprising, then, that a number of studies have investigated the role of EI in medical, dental and nursing students, however there is little reported evidence relating to EI development in pre-registration radiation therapy (RT) students.