Medical nutrition therapy and simple interventions can improve intake in patients who eat poorly in hospital

The Australasian Nutrition Care Day Survey (ANCDS) reported two-in-five patients in Australian and New Zealand hospitals consume ≤50% of the offered food. The ANCDS found a significant association between poor food intake and increased in-hospital mortality after controlling for confounders (nutritional status, age, disease type and severity)1. Evidence for the effectiveness of medical nutrition therapy (MNT) in hospital patients eating poorly is lacking. An exploratory study was conducted in respiratory, neurology and orthopaedic wards of an Australian hospital. At baseline, 24-hour food intake (0%, 25%, 50%, 75%, 100% of offered meals) was evaluated for patients hospitalised for ≥2 days and not under dietetic review. Patients consuming ≤50% of offered meals due to nutrition-impact symptoms were referred to ward dietitians for MNT with food intake re-evaluated on day-7. 184 patients were observed over four weeks. Sixty-two patients (34%) consumed ≤50% of the offered meals. Simple interventions (feeding/menu assistance, diet texture modifications) improved intake to ≥75% in 30 patients who did not require further MNT. Of the 32 patients referred for MNT, baseline and day-7 data were available for 20 patients (68±17years, 65% females, BMI: 22±5kg/m2, median energy, protein intake: 2250kJ, 25g respectively). On day-7, 17 participants (85%) demonstrated significantly higher consumption (4300kJ, 53g; p<0.01). Three participants demonstrated no improvement due to ongoing nutrition-impact symptoms. “Percentage food intake” was a quick tool to identify patients in whom simple interventions could enhance intake. MNT was associated with improved dietary intake in hospital patients. Further research is needed to establish a causal relationship.

School libraries and teacher-librarians : evidence of their contribution to student literacy and learning

International research provides compelling evidence that school libraries and teacher-librarians make a significant contribution to student literacy and learning outcomes. After summarising previous research, this article presents recent research focused on Gold Coast schools. These new Australian findings present an evidenced based snapshot of school libraries and teacher-librarians, from the principals’ perspective. They indicate that school NAPLAN scores for reading and writing were generally higher when student-to-library staff ratios were lower (i.e. better) and when the school employed a teacher-librarian. In light of the National Plan for School Improvement, the findings are of potential interest to education authorities, policy makers, school leadership teams, teacher-librarians, teachers, parents and researchers. They offer evidence to inform policy development and strategic planning for school libraries and professional staffing.

Using a Capability Maturity Model to build on the generational approach to student engagement practices

The generational approach to conceptualising first year student learning behaviour has made a useful contribution to understanding student engagement. It has an explicit focus on student behaviour and we suggest that a capability maturity model interpretation may provide a complementary extension of that understanding as it builds on the generational approach by allowing an assessment of institutional capability to initiate, plan, manage, evaluate and review institutional student engagement practices. The development of a Student Engagement, Success and Retention Maturity Model (SESR-MM) is discussed along with its application in an Australian higher education institution. In this case study, the model identified first, second and third generation approaches and in addition achieved a ‘complementary extension’ of the generational approach, building on it by identifying additional practices not normally considered within the generational concept and indicating the capability of the institution to provide and implement the practices.

The ACEN Student Scholarship: a profile of financial hardship and Work Integrated Learning

An increasing emphasis on embedding Work-Integrated Learning (WIL) in the curriculum has impacted on teaching and learning approaches in Australian higher education institutions (Higher Education Base Funding Review: Final Report, 2011). Yet whilst the benefits and costs of these approaches have been identified (Bradley, Noonan, Nugent, & Scales, 2008; Patrick et al., 2009) insufficient attention has been paid to financial costs experienced by students studying subjects with a Work Integrated Learning component. In 2010 the Australian Collaborative Education Network (ACEN) responded to this issue by offering three modest student scholarships based on evidence of hardship. Data collected from over 1000 applicants between 2010 and 2012 indicate travel, accommodation, food, clothing, equipment and loss of income are of major concern especially for students on lengthy placements involving relocation. At the same time the Australian Federal Government’s review of base funding has recommended a detailed assessment of the costs of providing student placements across all disciplines - in particular health and education (DEEWR, 2011, p.94). This paper considers costs from the student perspective and highlights major concerns identified through ACEN scholarship applications over a three year period. The implications for ACEN are described and recommendations documented which outline ACEN’s role in ensuring that these issues are given greater consideration across the sector.

Text messaging to support off-campus clinical facilitators of undergraduate student nurses

Managing large cohorts of undergraduate student nurses during off-campus clinical placement is complex and challenging. Clinical facilitators are required to support and assess nursing students during clinical placement. Therefore clear communication between university academic coordinators and clinical facilitators is essential for consistency and prompt management of emerging issues. Increasing work demands require both coordinators and facilitators to have an efficient and effective mode of communication. The aim of this study was to explore the use of Short Message Service (SMS) texts, sent between mobile phones, for communication between university Unit Coordinators and off-campus Clinical Facilitators. This study used an after-only design. During a two week clinical placement 46 clinical facilitators working with first and second year Bachelor of Nursing students from a large metropolitan Australian university were regularly sent SMS texts of relevant updates and reminders from the university coordinator. A 15 item questionnaire comprising x of 5 point likert scale and 3 open-ended questions was then used to survey the clinical facilitators. The response rate was 47.8% (n=22). Correlations were found between the approachability of the coordinator and facilitator perception of a) that the coordinator understood issues on clinical placement (r=0.785, p<0.001,), and b) being part of the teaching team (r=0.768, p<0.001). Analysis of responses to qualitative questions revealed three themes: connection, approachability and collaboration. Results indicate that SMS communication is convenient and appropriate in this setting. This quasi-experimental after-test study found regular SMS communication improves a sense of connection, approachability and collaboration.

Pulse: The London Symphony Orchestra Student Mobile Project

This report documents the key findings of a year-long collaborative research project focusing on the London Symphony Orchestra’s (LSO) development, implementation and testing of a mobile ticketing and information system. This ticketing system was developed in association with the LSO’s technical partners, Kodime Limited and in collaboration with the Aurora Orchestra.

Learner strategy instruction and student uptake of strategies in a Japanese as a foreign language context

The Japanese language is recognised as being more difficult than European languages, needing three times more tuition time to reach comparable levels of proficiency. Encouraging Japanese as a Foreign Language (JFL) students to become aware of, and effectively use, learner strategies is one way to assist them become more controlled, effective learners leading to enhanced language learning. This thesis investigates the development and implementation of a JFL curriculum implemented in a university course for students learning JFL. The curriculum was developed specifically to assist beginner university students with the development of learner strategies appropriate for a JFL reading context. The theoretical underpinning of the study was informed by Educational Criticism (Eisner, 1998), which aims to describe, interpret and evaluate the processes of interaction between the teacher, the learner and the curriculum and the students' learning processes in a tertiary JFL classroom. The study investigated the effect on student learning processes of a JFL reading program that incorporated explicit learner strategy instruction and identified factors that enhanced or impeded the development of learner strategy knowledge. The participants in the study were 29 students enrolled in the course, 10 of whom volunteered to undertake additional tasks, and the two teachers who implemented the curriculum. Data collection involved a number of different strategies to observe the students' participation in the classroom and learning experiences. Learning processes were investigated through TOL protocols, classroom observations, course evaluations, interviews, and learner strategy use measurement instruments (SILL, SILK and SORS) to document student uptake of learner strategies. The design of the study and its applied focus recognised my expertise as a JFL teacher, curriculum writer and researcher, an approach that aligns with the purpose of a Professional Doctorate. Four general thematics, or principles, were identified in this study: „h Explicit learner strategy instruction provides the context for students to develop awareness of learner strategies and take control of their learning; „h Collaborative learning and interaction with teachers offers students the opportunity for shared knowledge construction; „h Reflection offers teachers and students the opportunity to reflect on their own learning style and strategy knowledge, and raises awareness of other available strategies; and „h Diverse cultural and linguistic backgrounds have an impact on curriculum implementation and student uptake of learner strategies. The study¡¦s methodological contribution is that it is one of the first in Australia to use Educational Criticism (Eisner, 1998) as a research methodology. The findings contribute to theoretical knowledge in the fields of Applied Linguistics, Second Language Teaching and Learning, Second Language Acquisition and JFL Teaching and Learning by offering new knowledge on the importance of learner strategies in the beginner JFL classroom, the potential of explicit strategy instruction, the value of reflection for both teachers and students, and the important role of the teacher in the process of curriculum implementation. The general principles identified and the findings of this in-depth study of a JFL classroom can be drawn upon to inform other teaching practice situations, and invite practitioners from not just Japanese, but from other language areas and other disciplines, to examine and improve their own practices, and suggest further research questions to pursue this line of enquiry.

An exploratory study to evaluate whether medical nutrition therapy can improve dietary intake in hospital patients who eat poorly

Background and aims The Australasian Nutrition Care Day Survey (ANCDS) reported two-in-five patients consume ≤50% of the offered food in Australian and New Zealand hospitals. After controlling for confounders (nutritional status, age, disease type and severity), the ANCDS also established an independent association between poor food intake and increased in-hospital mortality. This study aimed to evaluate if medical nutrition therapy (MNT) could improve dietary intake in hospital patients eating poorly. Methods An exploratory pilot study was conducted in the respiratory, neurology and orthopaedic wards of an Australian hospital. At baseline, percentage food intake (0%, 25%, 50%, 75%, and 100%) was evaluated for each main meal and snack for a 24-hour period in patients hospitalised for ≥2 days and not under dietetic review. Patients consuming ≤50% of offered meals due to nutrition-impact symptoms were referred to ward dietitians for MNT. Food intake was re-evaluated on the seventh day following recruitment (post-MNT). Results 184 patients were observed over four weeks; 32 patients were referred for MNT. Although baseline and post-MNT data for 20 participants (68±17years, 65% females) indicated a significant increase in median energy and protein intake post-MNT (3600kJ/day, 40g/day) versus baseline (2250kJ/day, 25g/day) (p<0.05), the increased intake met only 50% of dietary requirements. Persistent nutrition impact symptoms affected intake. Conclusion In this pilot study whilst dietary intake improved, it remained inadequate to meet participants’ estimated requirements due to ongoing nutrition-impact symptoms. Appropriate medical management and early enteral feeding could be a possible solution for such patients.

Student identities in a mathematical community of practice : radical visible pedagogy and the teacher collective

This study investigated the practices of two teachers in a school that was successful in enabling the mathematical learning of students in Years 1 and 2, including those from backgrounds associated with low mathematical achievement. The study explained how the practices of the teachers constituted a radical visible pedagogy that enabled equitable outcomes. The study also showed that teachers’ practices have collective power to shape students’ mathematical identities. The role of the principal in the school was pivotal because she structured curriculum delivery so that students experienced the distinct practices of both teachers.

The role of nurse educators in student clinical education in Saudi Arabia

Introduction: Clinical education is considered a significant part of the learning process for nursing students. There is, however, no research that has explored this area of learning in Saudi Arabia. Theoretical Framework: Informed by a symbolic interactionist framework, this research explored the role of nurse educators in student clinical education in Saudi Arabia. Method: Using Glaserian grounded theory methods the data were derived from 14 face-to-face interviews with nurse educators from both hospital and faculty settings in King Abdu-Aziz University (KAU) and King Abdu-Aziz University Hospital (KAUH). Findings: The findings of the research are represented in the core category Redefining Identity Work and its two constituent categories Questioning the Situation and Creating Role Identity. The core and sub- categories were generated through a theoretical exploration of the identity work of nurse educators in Saudi Arabia. Conclusion: The social identity of the nurse educators was mediated culturally and socially within the hospital and university contexts and Saudi Arabian culture. In light of an increased understanding of the identity and role of nurse educators in clinical education in Saudi Arabia, the research presents implications and recommendations that may contribute to the development of nursing education as a coherent health care profession that is perceived as a desirable career option for Saudi women and men.

Encouraging, assisting, and time to eat : comparison of mealtime assistance interventions in elderly medical inpatients

BACKGROUND: The prevalence of protein-energy malnutrition in older adults is reported to be as high as 60% and is associated with poor health outcomes. Inadequate feeding assistance and mealtime interruptions may contribute to malnutrition and poor nutritional intake during hospitalisation. Despite being widely implemented in practice in the United Kingdom and increasingly in Australia, there have been few studies examining the impact of strategies such as Protected Mealtimes and dedicated feeding assistant roles on nutritional outcomes of elderly inpatients. AIMS: The aim of this research was to implement and compare three system-level interventions designed to specifically address mealtime barriers and improve energy intakes of medical inpatients aged ≥65 years. This research also aimed to evaluate the sustainability of any changes to mealtime routines six months post-intervention and to gain an understanding of staff perceptions of the post-intervention mealtime experience. METHODS: Three mealtime assistance interventions were implemented in three medical wards at Royal Brisbane and Women's Hospital: AIN-only: Additional assistant-in-nursing (AIN) with dedicated nutrition role. PM-only: Multidisciplinary approach to meals, including Protected Mealtimes. PM+AIN: Combined intervention: AIN + multidisciplinary approach to meals. An action research approach was used to carefully design and implement the three interventions in partnership with ward staff and managers. Significant time was spent in consultation with staff throughout the implementation period to facilitate ownership of the interventions and increase likelihood of successful implementation. A pre-post design was used to compare the implementation and nutritional outcomes of each intervention to a pre-intervention group. Using the same wards, eligible participants (medical inpatients aged ≥65 years) were recruited to the preintervention group between November 2007 and March 2008 and to the intervention groups between January and June 2009. The primary nutritional outcome was daily energy and protein intake, which was determined by visually estimating plate waste at each meal and mid-meal on Day 4 of admission. Energy and protein intakes were compared between the pre and post intervention groups. Data were collected on a range of covariates (demographics, nutritional status and known risk factors for poor food intake), which allowed for multivariate analysis of the impact of the interventions on nutritional intake. The provision of mealtime assistance to participants and activities of ward staff (including mealtime interruptions) were observed in the pre-intervention and intervention groups, with staff observations repeated six months post-intervention. Focus groups were conducted with nursing and allied health staff in June 2009 to explore their attitudes and behaviours in response to the three mealtime interventions. These focus group discussions were analysed using thematic analysis. RESULTS: A total of 254 participants were recruited to the study (pre-intervention: n=115, AIN-only: n=58, PM-only: n=39, PM+AIN: n=42). Participants had a mean age of 80 years (SD 8), and 40% (n=101) were malnourished on hospital admission, 50% (n=108) had anorexia and 38% (n=97) required some assistance at mealtimes. Occasions of mealtime assistance significantly increased in all interventions (p<0.01). However, no change was seen in mealtime interruptions. No significant difference was seen in mean total energy and protein intake between the preintervention and intervention groups. However, when total kilojoule intake was compared with estimated requirements at the individual level, participants in the intervention groups were more likely to achieve adequate energy intake (OR=3.4, p=0.01), with no difference noted between interventions (p=0.29). Despite small improvements in nutritional adequacy, the majority of participants in the intervention groups (76%, n=103) had inadequate energy intakes to meet their estimated energy requirements. Patients with cognitive impairment or feeding dependency appeared to gain substantial benefit from mealtime assistance interventions. The increase in occasions of mealtime assistance by nursing staff during the intervention period was maintained six-months post-intervention. Staff focus groups highlighted the importance of clearly designating and defining mealtime responsibilities in order to provide adequate mealtime care. While the purpose of the dedicated feeding assistant was to increase levels of mealtime assistance, staff indicated that responsibility for mealtime duties may have merely shifted from nursing staff to the assistant. Implementing the multidisciplinary interventions empowered nursing staff to "protect" the mealtime from external interruptions, but further work is required to empower nurses to prioritise mealtime activities within their own work schedules. Staff reported an increase in the profile of nutritional care on all wards, with additional non-nutritional benefits noted including improved mobility and functional independence, and better identification of swallowing difficulties. IMPLICATIONS: The PhD research provides clinicians with practical strategies to immediately introduce change to deliver better mealtime care in the hospital setting, and, as such, has initiated local and state-wide roll-out of mealtime assistance programs. Improved nutritional intakes of elderly inpatients was observed; however given the modest effect size and reducing lengths of hospital stays, better nutritional outcomes may be achieved by targeting the hospital-to-home transition period. Findings from this study suggest that mealtime assistance interventions for elderly inpatients with cognitive impairment and/or functional dependency show promise.

The role of nurse educators in student clinical education in Saudi Arabia

Background Clinical education is considered a significant part of the learning process for nursing students. There is, however, no research that has explored this area of learning in Saudi Arabia. Theoretical Framework Informed by a symbolic interactionist framework, this research explored the role of nurse educators in student clinical education in Saudi Arabia. Method Using Glaserian grounded theory methods the data were derived from 14 face-to-face interviews with nurse educators from both hospital and faculty settings in King Abdu-Aziz University (KAU) and King Abdu-Aziz University Hospital (KAUH). Findings The findings of the research are represented in the core category Redefining Identity Work and its two constituent categories Questioning the Situation and Creating Role Identity. The core and sub- categories were generated through a theoretical exploration of the identity work of nurse educators in Saudi Arabia. Conclusion The social identity of the nurse educators was mediated culturally and socially within the hospital and university contexts and Saudi Arabian culture. In light of an increased understanding of the identity and role of nurse educators in clinical education in Saudi Arabia, the research presents implications and recommendations that may contribute to the development of nursing education as a coherent health care profession that is perceived as a desirable career option for Saudi women and men.

Methods and consequences of suicide attempts among Australian students

Schweitzer et al. previously published a paper in the Australian and New Zealand Journal of Psychiatry which provided prevalence rates on suicidal ideation and behaviour among university students [1]. We wish to provide an update on extensions of our previously published work. In our previous publication we indicated the relatively high percentage of students who reported suicide-related behaviour over the past 12 months (6.6%). This figure is very similar to a more recent study undertaken in the UK where 6% of student respondents reported suicide attempts [2]. As a follow up, we investigated this finding further in studies undertaken in 1994 and 1997 by asking fresh samples of University of Queensland first-year undergraduates who responded positively to the question ‘I have made attempts to kill myself’ (in the past year), to provide additional data relating to the methods employed in their suicide attempts and the consequences following their suicide attempt in terms of level of injury and medical care received...

Prevalence of depressive symptoms as elicited by Patient Health Questionnaire (PHQ-9) among medical trainees in Oman

Background Despite the increasing recognition that medical training tends to coincide with markedly high levels of stress and distress, there is a dearth of validated measures that are capable of gauging the prevalence of depressive symptoms among medical residents in the Arab/Islamic part of the world. Objective The aim of the present study is two-fold. First is to examine the diagnostic validity of the Patient Health Questionnaire (PHQ-9) using an Omani medical resident population in order to establish a cut-off point. Second is to compare gender, age, and residency level among Omani Medical residents who report current depressive symptomatology versus those who report as non-depressed according to PHQ-9 cut-off threshold. Results A total of 132 residents (42 males and 90 females) consented to participate in this study. The cut-off score of 12 on the PHQ-9 revealed a sensitivity of 80.6% and a specificity of 94.0%. The rate of depression, as elicited by PHQ-9, was 11.4%. The role of gender, age, and residency level was not significant in endorsing depression. Conclusion This study indicated that PHQ-9 is a reliable measure among this cross-cultural population. More studies employing robust methodology are needed to confirm this finding.