The impact of surgical ward nurses practicing respiratory assessment on positive patient outcomes

Objective: A literature review to examine the incorporation of respiratory assessment into everyday surgical nursing practice; possible barriers to this; and the relationship to patient outcomes. Primary argument: Escalating demands on intensive care beds have led to highly dependent patients being cared for in general surgical ward areas. This change in patient demographics has meant the knowledge and skills required of registered nurses in these areas has expanded exponentially. The literature supported the notion that postoperative monitoring of vital signs should include the fundamental assessment of respiratory rate; depth and rhythm; work of breathing; use of accessory muscles and symmetrical chest movement; as well as auscultation of lung fields using a stethoscope. Early intervention in response to changes in a patient's respiratory health status impacts positively on patient health outcomes. Substantial support exists for the contention that technologically adept nurses who also possess competent respiratory assessment skills make a difference to respiratory care. Conclusions: Sub-clinical respiratory problems have been demonstrated to contribute to adverse events. There is a paucity of research knowledge as to whether respiratory education programs and associated inservice make a difference to nursing clinical practice. Similarly, the implications for associated respiratory educational needs are not well documented, nor has a research base been sufficiently developed to guide nursing practice. Further research has the potential to influence the future role and function of the registered nurse by determining the importance of respiratory education programs on post-operative patient outcomes.

Planning for transit system reliability using productive performance and risk assessment

Urban transit system performance may be quantified and assessed using transit capacity and productive capacity for planning, design and operational management. Bunker (4) defines important productive performance measures of an individual transit service and transit line. Transit work (p-km) captures transit task performed over distance. Transit productiveness (p-km/h) captures transit work performed over time. This paper applies productive performance with risk assessment to quantify transit system reliability. Theory is developed to monetize transit segment reliability risk on the basis of demonstration Annual Reliability Event rates by transit facility type, segment productiveness, and unit-event severity. A comparative example of peak hour performance of a transit sub-system containing bus-on-street, busway, and rail components in Brisbane, Australia demonstrates through practical application the importance of valuing reliability. Comparison reveals the highest risk segments to be long, highly productive on street bus segments followed by busway (BRT) segments and then rail segments. A transit reliability risk reduction treatment example demonstrates that benefits can be significant and should be incorporated into project evaluation in addition to those of regular travel time savings, reduced emissions and safety improvements. Reliability can be used to identify high risk components of the transit system and draw comparisons between modes both in planning and operations settings, and value improvement scenarios in a project evaluation setting. The methodology can also be applied to inform daily transit system operational management.

Planning for transit system reliability using productive performance and risk assessment

Urban transit system performance may be quantified and assessed using transit capacity and productive capacity for planning, design and operational management. Bunker (4) defines important productive performance measures of an individual transit service and transit line. Transit work (p-km) captures transit task performed over distance. Transit productiveness (p-km/h) captures transit work performed over time. This paper applies productive performance with risk assessment to quantify transit system reliability. Theory is developed to monetize transit segment reliability risk on the basis of demonstration Annual Reliability Event rates by transit facility type, segment productiveness, and unit-event severity. A comparative example of peak hour performance of a transit sub-system containing bus-on-street, busway, and rail components in Brisbane, Australia demonstrates through practical application the importance of valuing reliability. Comparison reveals the highest risk segments to be long, highly productive on street bus segments followed by busway (BRT) segments and then rail segments. A transit reliability risk reduction treatment example demonstrates that benefits can be significant and should be incorporated into project evaluation in addition to those of regular travel time savings, reduced emissions and safety improvements. Reliability can be used to identify high risk components of the transit system and draw comparisons between modes both in planning and operations settings, and value improvement scenarios in a project evaluation setting. The methodology can also be applied to inform daily transit system operational management.

Assessment bias : physical activity questionnaire assessment inadvertently influences patients’ desire to be ‘more physically active’

Evaluating physical activity is important for public health population research and evaluating lifestyle interventions among targeted groups. Self-reported questionnaires are frequently used to evaluate physical activity in a variety of contexts where resource or pragmatic limitations prohibit the use of more sophisticated approaches. However, prior research in the use of other patient reported outcomes in healthcare settings has highlighted that simply completing a questionnaire may change a patients’ behaviour or responses to subsequent questions. This methodology study aimed to examine whether completing a standard physical activity questionnaire altered patients responses to two related questions a) whether they are ‘sufficiently physically active’ and b) whether they desire ‘to be more physically active.’

Faculty mentoring, evidence-based assessment, and student learning : an Australian exploration of American initiatives

There have been many improvements in Australian engineering education since the 1990s. However, given the recent drive for assuring the achievement of identified academic standards, more progress needs to be made, particularly in the area of evidence-based assessment. This paper reports on initiatives gathered from the literature and engineering academics in the USA, through an Australian National Teaching Fellowship program. The program aims to establish a process to help academics in designing and implementing evidence-based assessments that meet the needs of not only students and the staff that teach them, but also industry as well as accreditation bodies. The paper also examines the kinds and levels of support necessary for engineering academics, especially early career ones, to help meet the expectations of the current drive for assured quality and standards of both research and teaching. Academics are experiencing competing demands on their time and energy with very high expectations in research performance and increased teaching responsibilities, although many are researchers who have not had much pedagogic training. Based on the literature and investigation of relevant initiatives in the USA, we conducted interviews with several identified experts and change agents who have wrought effective academic cultural change within their institutions and beyond. These reveal that assuring the standards and quality of student learning outcomes through evidence-based assessments cannot be appropriately addressed without also addressing the issue of pedagogic training for academic staff. To be sustainable, such training needs to be complemented by a culture of on-going mentoring support from senior academics, formalised through the university administration, so that mentors are afforded resources, time, and appropriate recognition.

Quantitative assessment of fault tolerant precision timing for electricity substations

Advanced substation applications, such as synchrophasors and IEC 61850-9-2 sampled value process buses, depend upon highly accurate synchronizing signals for correct operation. The IEEE 1588 Precision Timing Protocol (PTP) is the recommended means of providing precise timing for future substations. This paper presents a quantitative assessment of PTP reliability using Fault Tree Analysis. Two network topologies are proposed that use grandmaster clocks with dual network connections and take advantage of the Best Master Clock Algorithm (BMCA) from IEEE 1588. The cross-connected grandmaster topology doubles reliability, and the addition of a shared third grandmaster gives a nine-fold improvement over duplicated grandmasters. The performance of BMCA mediated handover of the grandmaster role during contingencies in the timing system was evaluated experimentally. The 1 µs performance requirement of sampled values and synchrophasors are met, even during network or GPS antenna outages. Slave clocks are shown to synchronize to the backup grandmaster in response to degraded performance or loss of the main grandmaster. Slave disturbances are less than 350 ns provided the grandmaster reference clocks are not offset from one another. A clear understanding of PTP reliability and the factors that affect availability will encourage the adoption of PTP for substation time synchronization.

Applied sub-transmission & distribution reliability assessment of SEQEB network in Queensland

In this paper a combined subtransmission and distribution reliability analysis of SEQEB’s outer suburban network is presented. The reliability analysis was carried out with a commercial software package which evaluates both energy and customer indices. Various reinforcement options were investigated to ascertain the impact they have on the reliability of supply seen by the customers. The customer and energy indices produced by the combined subtransmission and distribution reliability studies contributed to optimise capital expenditure to the most effective areas of the network.

Multi-area reliability assessment of interconnected generating systems using hybrid approach

This paper present an efficient method using system state sampling technique in Monte Carlo simulation for reliability evaluation of multi-area power systems, at Hierarchical Level One (HLI). System state sampling is one of the common methods used in Monte Carlo simulation. The cpu time and memory requirement can be a problem, using this method. Combination of analytical and Monte Carlo method known as Hybrid method, as presented in this paper, can enhance the efficiency of the solution. Incorporation of load model in this study can be utilised either by sampling or enumeration. Both cases are examined in this paper, by application of the methods on Roy Billinton Test System(RBTS).

An assessment for cost effective maintenance and operation of the Callide Power Station electrical system, using reliability evaluation

The reliable operation of the electrical system at Callide Power Station is of extreme importance to the normal everyday running of the Station. This study applied the principles of reliability to do an analysis on the electrical system at Callide Power Station. It was found that the level of expected outage cost increased exponentially with a declining level of maintenance. Concluding that even in a harsh economic electricity market where CS Energy tries and push their plants to the limit, maintenance must not be neglected. A number of system configurations were found to increase the reliability of the system and reduce the expected outage costs. A number of other advantages were identified as a result of using reliability principles to do this study on the Callide electrical system configuration.

Maintenance considerations in applied substation reliability assessment

This paper presents a reliability assessment of a substation, part of the Queensland transmission network in Australia. As part of a maintenance considerations, this study utilises the substation reliability assessment package STAREL to quantitatively compare the reliability improvement achieved by two circuit breaker reinforcement alternatives for Swanbank circuit breaker replacement or refurbishment. Substation reliability is interpreted on the basis of outage frequency and outage duration indices for each individual transmission line terminated in Swanbank 'B' substation. By considering the reliability indices in this paper with the cost associated conducted by POWERLINK Queensland, a Swanbank 'B' reinforcement alternative can be selected that optimises both transmission line security and the costs incurred in achieving it.

Towards improving public understanding of judgement practice in standards-referenced assessment : an Australian perspective

Internationally there has been a move towards standards-referenced assessment with countries such as Australia developing a National Curriculum and Achievement Standards, New Zealand adopting National Standards for literacy and numeracy that involve schools making and reporting judgements about the reading, writing and mathematics achievement of children up to Year 8 (the end of primary school) and in Canada, classroom assessment standards aimed at the improvement of assessment practice of K-12 education are being formulated. Standards-driven reform has major implications for teachers’ work. The consequences of adopting a standards-driven approach to educational change by systems are often under-estimated with the unintended effects not fully understood by either the policy writers, and the public, including parents. It is for these reasons that the contention developed in this article relates to the teacher’s role, which it is argued remains central to policy focused on the improvement of the quality of education and educational standards.