Nursing physical assessment for patient safety in general wards: Reaching consensus on core skills

Aims and objectives To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Background Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. Design A modified Delphi study. Methods Focus group interviews with 150 acute care registered nurses (RNs) at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care RNs following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Results Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Conclusions Among a large and diverse group of experienced acute care RNs consensus was achieved on a structured core physical assessment to detect early changes in patient status. Relevance to clinical practice Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.

Development, reliability and validity of the queensland evaluation of wheelchair skills (QEWS)

- Objectives To develop and test a valid and reliable assessment of wheelchair skills for individuals with spinal cord injuries (SCI); the Queensland Evaluation of Wheelchair Skills (QEWS). - Setting Hospital, Australia. - Methods Phase 1: Four Delphi panel rounds with clinical experts were used to develop the QEWS. Phase 2: Intra-rater and inter-rater reliability of the QEWS items were examined in 100 people with SCI. Phase 3a: Concurrent validity was investigated by examining the association between QEWS total scores and physiotherapists’ global ratings of wheelchair skill performance. Phase 3b: Construct validity was tested in 20 people with recent SCI by examining change in QEWS total scores between when they first mobilised in a wheelchair and scores obtained 10 weeks later. - Results Phase 1: The QEWS was developed. Phase 2: The intra-class correlation coefficients reflecting the intra-rater reliability and the inter-rater reliability for the QEWS total score were 1.00 and 0.98, with scores being within one point of each other 96 and 91% of the time, respectively. Phase 3a: The QEWS total scores were comparable with the global rating of wheelchair skill performance (r2=0.93). Phase 3b: The QEWS scores changed by a median (interquartile range (IQR)) of 4 (1 to 6) points over the 10-week period following first wheelchair mobilisation. - Conclusion The QEWS is a valid and reliable tool for measuring wheelchair skills in individuals with SCI. The QEWS is efficient and practical to administer and does not require specialised equipment.

Patient Safety - A Psychological Perspective

This comprehensive book takes a psychological perspective on patient safety. It is based on the most recent theoretical and empirical research evidence from psychology (including clinical, work, and organizational psychology) and adjacent social and behavioral sciences such as human factors. Factors that influence safety-related experiences, behaviors, and outcomes of patients and professionals working in clinical settings such as medical practices and hospitals are reviewed, structured, and critically evaluated. Consistent with the complexity of the topic, the author takes a multi-level approach to patient safety, which includes a review of individual, team, and organizational factors and outcomes. The book describes how these factors, by themselves and in combination, can facilitate or impede patient safety. Individual factors include safety-relevant knowledge, skills, abilities, and personality traits such as conscientiousness and emotional stability. Team factors include group communication, training, and leadership. Finally, organizational factors include the safety culture and climate. Throughout the book, different evidence-based intervention programs are described that can help practitioners promote patient safety and prevent accidents. The book is a valuable resource for both researchers and practitioners interested in understanding, maintaining, and improving patient safety in a variety of applied settings. It is based on the most up-to-date research evidence from psychology and neighboring disciplines, and it is written in a clear and non-technical language understandable for a wide audience.

Transition to school: Using multilingual storybooks in linguistically diverse settings

Community languages have a place in early years education for children in prior-to-school settings and students in formal schooling. Australian curricula treat the languages of the local community as both content and resource for learning. In this article we look at the potential of dual language and multiple language storybooks for teaching about linguistic diversity and developing literacy skills, highlighting the potential of paired and shared reading.

Creating employability skills in SMEs: Modification through interaction

This paper is concerned with the degree to which the graduate skills required by industry are developed in Australian universities. Despite acknowledgement of the need to increase the graduate skills of students, it would seem that the stated intentions of Australian universities in this respect do not yet meet the expectations of industry. The development of an enterprise program at the University of Tasmania provides by way of example, support that the development of industry-desired skills is possible alongside the desirable knowledge outcomes of a university. It is argued that lecturers and students must give and accept more responsibility for learning to enable the development of desirable graduate skills.

Bridging the gap: Curriculum practices in community language schools and their challenges

This study investigated curriculum practices in Queensland community language schools and how these practices are supported by government policy. The conceptual framework drew on theories of ethnolinguistic vitality and curriculum dimensions. The research design involved case studies of two community language schools of different sizes, using classroom observation and interviews. Cross–case analysis revealed contrasting curriculum practices determined by student enrolments, and different capacities to access and benefit from what policy support was available. This study offers some implications and possibilities to better support quality curriculum practices in community language schools.

The neuroscience of inspirational leadership: the importance of collective-oriented language and shared group membership

Effective leaders are believed to inspire followers by providing inclusive visions of the future that followers can identify with. In the present study, we examined the neural mechanisms underlying this process, testing key hypotheses derived from transformational and social identity approaches to leadership. While undergoing functional MRI, supporters from the two major Australian political parties (Liberal vs. Labor) were presented with inspirational collective-oriented and noninspirational personal-oriented statements made by in-group and out-group leaders. Imaging data revealed that inspirational (rather than noninspirational) statements from in-group leaders were associated with increased activation in the bilateral rostral inferior parietal lobule, pars opercularis, and posterior midcingulate cortex: brain areas that are typically implicated in controlling semantic information processing. In contrast, for out-group leaders, greater activation in these areas was associated with noninspirational statements. In addition, noninspirational statements by in-group (but not out-group) leaders resulted in increased activation in the medial prefrontal cortex, an area typically associated with reasoning about a person’s mental state. These results show that followers processed identical statements qualitatively differently as a function of leaders’ group membership, thus demonstrating that shared identity acts as an amplifier for inspirational leadership communication.

Validating adult and paediatric nutrition screening and assessment tools in Vietnamese language in two acute hospital in Ho Chi Minh City, Vietnam

Despite being commonly prevalent in acute care hospitals worldwide, malnutrition often goes unidentified and untreated due to a lack in the implementation of a nutrition care pathway. The aim of this study was to validate nutrition screening and assessment tools in Vietnamese language. After converting into Vietnamese, Malnutrition Screening Tool (MST) and Subjective Global Assessment (SGA) were used to identify malnutrition in the adult setting; and the Paediatric Nutrition Screening Tool (PNST) and paediatric Subjective Global Nutritional Assessment (SGNA) were used in the paediatric setting in two acute care hospitals in Vietnam. This cross-sectional observational study sampled 123 adults (median age 78 years [39–96 years], 63% males) and 105 children (median age 20 months [2–100 months], 66% males). In adults, nutrition risk and malnutrition were identified in 29% and 45% of the cohort respectively. Nutrition risk and malnutrition were identified in 71% and 43% of the paediatric cohort respectively. The sensitivity and specificity of the screening tools were: 62% and 99% for the MST compared to the SGA; 89% and 42% for the PNST compared to the SGNA. This study provides a stepping stone to the potential use of evidence-based nutrition screening and assessment tools in Vietnamese language within the adult and paediatric Vietnamese acute care setting. Further work is required into integrating a complete nutrition care pathway within the acute care setting in Vietnamese hospitals.

The gradual release of responsibility: A case study of teaching science inquiry skills

This thesis investigated how a year-4 teacher used a pedagogical approach referred to as the Gradual Release of Responsibility (GRR) model of instruction for teaching Science Inquiry Skills in a primary classroom. Through scaffolding her students' learning using the GRR, the teacher guided her students towards developing an understanding about Scientific Inquiry leading to the foundations of scientific literacy. A learning environment was established in which students engaged in rich conversations, designed and conducted experiments using fair testing procedures, analysed and offered justifications for results, and negotiated knowledge claims in ways similar to some of those in the scientific community.

'Create a Better Online You': Designing online learning resources to develop undergraduate social media skills

This article charts the development of the 'Create a Better Online You' (CBOY) project. The focus of CBOY was the social media skills of undergraduate students at QUT. While many students will have encountered 'cybersafety' training in primary or secondary school, however, a comprehensive environmental scan revealed little in the way of social media resources targeted at undergraduate students. In particular, there was little to no focus on the ways in which social media could be used strategically to develop a positive online reputation and enhance chances of employability post tertiary education. The resources created as part of CBOY were the result of a comprehensive literature review, environmental scan, interviews with key internal and external stakeholders, and in discussion with undergraduate students at Queensland University of Technology (QUT). Following the comprehensive environmental scan, it appears that CBOY represents one of the first free, openly accessible, interactive resources targeting the social media skills of undergraduates.

Formalising the vernacular: Social media skills in higher education

This paper discusses the issue of social media skills using a literacy framework. Firstly, it argues that social media skills are a form of vernacular, or ‘everyday’, literacy and articulates the issues associated with trying to formalise these skills within the curriculum. Secondly, it calls for greater explicit attention to social media skills within higher education, by arguing that social media literacies are a part of new literacies. It evaluates QUT’s “Create a Better Online You” suite of social media resources in light of this framework, and discusses the role of libraries in addressing social media skills.

Blended learning in medical imaging pre-clinical skills training – does it work?

Undergraduate Medical Imaging (MI)students at QUT attend their first clinical placement towards the end of semester two. Students undertake two (pre)clinical skills development units – one theory and one practical. Students gain good contextual and theoretical knowledge during these units via a blended learning model with multiple learning methods employed. Students attend theory lectures, practical sessions, tutorial sessions in both a simulated and virtual environment and also attend pre-clinical scenario based tutorial sessions. The aim of this project is to evaluate the use of blended learning in the context of 1st year Medical Imaging Radiographic Technique and its effectiveness in preparing students for their first clinical experience. It is hoped that the multiple teaching methods employed within the pre-clinical training unit at QUT builds students clinical skills prior to the real situation. A quantitative approach will be taken, evaluating via pre and post clinical placement surveys. This data will be correlated with data gained in the previous year on the effectiveness of this training approach prior to clinical placement. In 2014 59 students were surveyed prior to their clinical placement demonstrated positive benefits of using a variety of learning tools to enhance their learning. 98.31%(n=58)of students agreed or strongly agreed that the theory lectures were a useful tool to enhance their learning. This was followed closely by 97% (n=57) of the students realising the value of performing role-play simulation prior to clinical placement. Tutorial engagement was considered useful for 93.22% (n=55) whilst 88.14% (n=52) reasoned that the x-raying of phantoms in the simulated radiographic laboratory was beneficial. Self-directed learning yielded 86.44% (n=51). The virtual reality simulation software was valuable for 72.41% (n=42) of the students. Of the 4 students that disagreed or strongly disagreed with the usefulness of any tool they strongly agreed to the usefulness of a minimum of one other learning tool. The impact of the blended learning model to meet diverse student needs continues to be positive with students engaging in most offerings. Students largely prefer pre -clinical scenario based practical and tutorial sessions where 'real-world’ situations are discussed.

Juggling priorities: Balancing economic and social drivers to address the LLN needs of students in the VET sector

Economic success, and a commitment to the social benefits of inclusive training opportunities are important goals for public vocational education and training (VET). Currently, in Australia, VET policy is a shared responsibility between the Commonwealth and the States and Territories. Priorities for investment are juggled between: a) improving efficiency and responsiveness; and b) providing societal prosperity. Amid recent VET educational reforms and policy directives the authors of this paper undertook a pilot study examining language, literacy and numeracy support and inclusive teaching and learning practices in a Diploma of Nursing course. The data highlighted implications arising from new market driven education reforms. This article reports on identified factors that influenced inclusive learning opportunities, noticeably associated with two recent policy developments: the release of the FSK Foundation Skills Training Package (IBSA 2014); and the Queensland's Higher Skills Program Policy 2014-15.