Reducing falls in hospital through education to change patient and staff behaviour: A stepped wedge cluster randomised controlled effectiveness trial

Background: Falls remain the most frequent adverse event reported in hospitals, particularly geriatric rehabilitation wards. Randomised trials reducing fall injuries in hospitals have been elusive. Our previous randomised trial (n = 1206) demonstrated that multimedia education with physiotherapist falls educator support reduced falls among patients with higher cognition levels, but this benefit was offset by a potential increase in falls rates among patients with poor cognition. In the previous trial, hospital staff were blinded to the allocation of individual patients, and only delivered usual care.

A Malaysian tale : pre-service teacher education and ICT integration for a better world

The use of Information and Communication Technologies (ICT) in education is often a topic of much discussion within all sectors of education with educators and educational researchers continually looking for innovative ways of using these technologies to support and enhance student outcomes in education. Consequently, Malaysia is no exception to this and as the Ministry of Education (MOE), Malaysia strives to meet its government’s Vision 2020, educational reform across all educational sectors has become imperative. ICT will play an integral role in the educational reform process and teacher education programs are no exception to this. ICT and capacity building will play an important role in the re-conceptualisation of teacher education programs. This paper reports on how a collaborative capacity building project between two Malaysian teacher education Institutes and an Australian University has given lecturers and pre-service teachers an opportunity to redefine their use of ICT in their prospective teaching areas of science, mathematics and design and technology. It also highlights the positive capacity building programs that occurred between both Australian university lecturers and Malaysian Institute lecturers and how this contributed to the effective integration and use of ICT.

Assessment in education : principles, policy and practice

The English examination system provides a market in which a limited number of providers are accredited to offer curriculum-based examinations in many subject areas and at several levels. The most significant are the General Certificate of Secondary Education (GCSE) and the General Certificate of Education, Advanced (A level). Because these examinations are used for high-stakes purposes, including higher education and employment selection for individuals and programme evaluation for institutions, it is desired that scores from various exams be ‘comparable’ in several respects: across syllabuses and examination boards within a subject area, across years, and even across subject areas. Just how to accomplish this goal has been a topic of continual research and debate for over 50 years, through many changes of examination and institutional structures. But ever year, tens of thousands of scores must be reported, and every year, users expect them to ‘be comparable’ and use them as if they are.

Australia : LIS education

The topic of library and information science (LIS) education has been under the spotlight in the professional literature in Australia and New Zealand for a number of years. Critical issues of discussion encompass the apparent lack of a core curriculum for the discipline, the perceived gulf between LIS education and LIS practice, and the pressing need for career-long learning and development. One of the central points of debate that emerges repeatedly is the long-standing question about the positioning of the profession: Is LIS a graduate profession of highly skilled individuals valued for their expertise and professionalism or is it a profession of anyone who works in a library, regardless of their qualifications (LIANZA, 2005)? While Australia and New Zealand do not stand alone in this debate – similar issues are echoed in many other countries – there are inevitably some local characteristics which warrant exploration. The discussion presented here highlights the historical background to professional training, the specific professional policies and standards that guide LIS education and some of the challenges facing professional and paraprofessional education, given the changing environment of education in Australia as a whole, with some comparisons made with the New Zealand situation. While all too often library practitioners point the finger at the library educators to ‘right the wrongs’, the authors wish to reinforce the idea that the future of effective and relevant LIS education is a matter for all stakeholders in the profession: practitioners and educators, students and staff, employers and employees, with cohesion potentially offered by the professional body.

ERP systems in the higher education sector : a descriptive study

In response to a range of contextual drivers, the worldwide adoption of ERP Systems in Higher Education Institutions (HEIs) has increased substantially over the past decade. Though this demand continues to grow, with HEIs now a main target market for ERP vendors, little has been published on the topic. This paper reports a sub-study of a larger research effort that aims to contribute to understanding the phenomenon of ERP adoption and evaluation in HEIs in the Australasian region. It presents a descriptive case study conducted at Queensland University of Technology (QUT) in Australia, with emphasis on challenges with ERP adoption. The case study provides rich contextual details about ERP system selection, customisation, integration and evaluation, and insights into the role of consultants in the HE sector. Through this analysis, the paper (a) provides evidence of the dearth of ERP literature pertaining to the HE sector; (b) yields insights into differentiating factors in the HE sector that warrants specific research attention, and (c) offers evidence of how key ERP decisions such as systems selection, customisation, integration, evaluation, and consultant engagement are influenced by the specificities of the HE sector.

Book review : "Community engagement in contemporary legal education : Pro Bono, Clinical legal education and services learning"

The result of a forum on community engagement held in November 2008 at Bond University, Community Engagement in Contemporary Legal Education is a compilation of papers presented at the forum by academics and professionals throughout Australia. Although found initially to be a topic of legal interest, it was not until the reviewer came across the Council of Australian Law Deans (CALD) “Standards for Australian Law Schools” (adopted 17 November 20093) then the full importance and potential of this book was revealed. Clause 2.2.4 of the CALD Standards recognises the importance of “experiential learning opportunities” for law students and cites examples such as clinical programs, internships, practical experience and pro-bono work. Clause 2.3.3 acknowledges the need to develop professional ethics and again cites pro-bono obligations as an example. Clause 9.6.2 encourages interaction of law schools with the profession and the community and again, pro-bono community service is identified as one method of doing so. Yet nowhere in the document are there any uniform standards or binding obligations that law schools must commit to. In the current climate where the importance of practical experience is continually emphasised and student numbers exceed the number of available paid legal positions, there should be more focus on the details of how these commitments should be converted to be included in a law school’s curriculum.

Patient preference for falls prevention in hospitals revealed through willingness-to-pay, contingent valuation survey

Rationale, aims and objectives: Patient preference for interventions aimed at preventing in-hospital falls has not previously been investigated. This study aims to contrast the amount patients are willing to pay to prevent falls through six intervention approaches. ----- ----- Methods: This was a cross-sectional willingness-to-pay (WTP), contingent valuation survey conducted among hospital inpatients (n = 125) during their first week on a geriatric rehabilitation unit in Queensland, Australia. Contingent valuation scenarios were constructed for six falls prevention interventions: a falls consultation, an exercise programme, a face-to-face education programme, a booklet and video education programme, hip protectors and a targeted, multifactorial intervention programme. The benefit to participants in terms of reduction in risk of falls was held constant (30% risk reduction) within each scenario. ----- ----- Results: Participants valued the targeted, multifactorial intervention programme the highest [mean WTP (95% CI): $(AUD)268 ($240, $296)], followed by the falls consultation [$215 ($196, $234)], exercise [$174 ($156, $191)], face-to-face education [$164 ($146, $182)], hip protector [$74 ($62, $87)] and booklet and video education interventions [$68 ($57, $80)]. A ‘cost of provision’ bias was identified, which adversely affected the valuation of the booklet and video education intervention. ----- ----- Conclusion: There may be considerable indirect and intangible costs associated with interventions to prevent falls in hospitals that can substantially affect patient preferences. These costs could substantially influence the ability of these interventions to generate a net benefit in a cost–benefit analysis.

Parents’ views about child sexual abuse prevention education : a systematic review

This paper presents the results of a systematic review of literature on the topic of parents’ views about child sexual abuse prevention education. It describes: i) what parents know about child sexual abuse prevention education; ii) what child sexual abuse prevention messages parents provide to their children and what topics they discuss; iii) what parents’ attitudes are towards child sexual abuse prevention education in schools; and iv) their preferences for content. Electronic database searches were conducted to identify relevant literature published in English relating to child sexual abuse prevention programs and parent’s views. A total of 429 papers were evaluated with 13 studies identified as meeting the study’s inclusion criteria. Worldwide, empirical research on parents’ views about child sexual abuse prevention programs is limited and more research is needed in Australia. Implications for future research and practice are outlined.

Development and evaluation of an integrated clinical learning model to inform continuing education for acute care nurses

Background Significant ongoing learning needs for nurses have occurred as a direct result of the continuous introduction of technological innovations and research developments in the healthcare environment. Despite an increased worldwide emphasis on the importance of continuing education, there continues to be an absence of empirical evidence of program and session effectiveness. Few studies determine whether continuing education enhances or develops practice and the relative cost benefits of health professionals’ participation in professional development. The implications for future clinical practice and associated educational approaches to meet the needs of an increasingly diverse multigenerational and multicultural workforce are also not well documented. There is minimal research confirming that continuing education programs contribute to improved patient outcomes, nurses’ earlier detection of patient deterioration or that standards of continuing competence are maintained. Crucially, evidence-based practice is demonstrated and international quality and safety benchmarks are adhered to. An integrated clinical learning model was developed to inform ongoing education for acute care nurses. Educational strategies included the use of integrated learning approaches, interactive teaching concepts and learner-centred pedagogies. A Respiratory Skills Update education (ReSKU) program was used as the content for the educational intervention to inform surgical nurses’ clinical practice in the area of respiratory assessment. The aim of the research was to evaluate the effectiveness of implementing the ReSKU program using teaching and learning strategies, in the context of organisational utility, on improving surgical nurses’ practice in the area of respiratory assessment. The education program aimed to facilitate better awareness, knowledge and understanding of respiratory dysfunction in the postoperative clinical environment. This research was guided by the work of Forneris (2004), who developed a theoretical framework to operationalise a critical thinking process incorporating the complexities of the clinical context. The framework used educational strategies that are learner-centred and participatory. These strategies aimed to engage the clinician in dynamic thinking processes in clinical practice situations guided by coaches and educators. Methods A quasi experimental pre test, post test non–equivalent control group design was used to evaluate the impact of the ReSKU program on the clinical practice of surgical nurses. The research tested the hypothesis that participation in the ReSKU program improves the reported beliefs and attitudes of surgical nurses, increases their knowledge and reported use of respiratory assessment skills. The study was conducted in a 400 bed regional referral public hospital, the central hub of three smaller hospitals, in a health district servicing the coastal and hinterland areas north of Brisbane. The sample included 90 nurses working in the three surgical wards eligible for inclusion in the study. The experimental group consisted of 36 surgical nurses who had chosen to attend the ReSKU program and consented to be part of the study intervention group. The comparison group included the 39 surgical nurses who elected not to attend the ReSKU program, but agreed to participate in the study. Findings One of the most notable findings was that nurses choosing not to participate were older, more experienced and less well educated. The data demonstrated that there was a barrier for training which impacted on educational strategies as this mature aged cohort was less likely to take up educational opportunities. The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group’s reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales following attendance at the ReSKU program. These subscales included influence on nursing care, educational preparation and clinical development. Findings suggest that the use of an integrated educational model underpinned by a robust theoretical framework is a strong factor in some perceptions of the ReSKU program relating to attitudes and behaviour. There were minimal differences in knowledge between groups across time. Conclusions This study was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies and a robust overarching theoretical framework to support study concepts. The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful and collective reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

Nurses driving change to improve access to education and quality in lcinical teaching : A partnership between Australia and Viet Nam

In Viet Nam, standards of nursing care fail to meet international competency standards. This increases risks to patient safety (eg. hospital acquired infection), consequently the Ministry of Health identified the need to strengthen nurse education in Viet Nam. This paper presents experiences of a piloted clinical teaching model developed in Ha Noi, to strengthen nurse led institutional capacity for in-service education and clinical teaching. Historically 90% of nursing education was conducted by physicians and professional development in hospitals for nurses was limited. There was minimal communication between hospitals and nursing schools about expectations of students and assessment and quality of the learning experience. As a result when students came to the clinical sites, no-one understood how to plan their learning objectives and utilise teaching and learning approaches appropriate to their level. Therefore student learning outcomes were variable. They focussed on procedures and techniques and “learning how to do” rather than learning how to plan, implement and evaluate patient care. This project is part of a multi-component capacity building program designed to improve nurse education in Viet Nam. The project was funded jointly by Queensland University of Technology (QUT) and the Australian Agency for International Development. Its aim was to develop a collaborative clinically-based model of teaching to create an environment that encourages evidence-based, student-centred clinical learning. Accordingly, strategies introduced promoted clinical teaching of competency based nursing practice utilising the regionally endorsed nurse core competency standards. Thirty nurse teachers from Viet Duc University Hospital and Hanoi Medical College participated in the program. These nurses and nurse teachers undertook face to face education in three workshops, and completed three assessment items. Assessment was applied, where participants integrated the concepts learned in each workshop and completed assessment tasks related to planning, implementing and evaluating teaching in the clinical area. Twenty of these participants were then selected to undertake a two week study tour in Brisbane, Australia where the clinical teaching model was refined and an action plan developed to integrate into both organisations with possible implementation across Viet Nam. Participants on this study tour also experienced clinical teaching and learning at QUT by attending classes held at the university, and were able to visit selected hospitals to experience clinical teaching in these settings as well. Effectiveness of the project was measured throughout the implementation phase and in follow up visits to the clinical site. To date changes have been noted on an individual and organisational level. There is also significant planning underway to incorporate the clinical teaching model developed across the organisation and how this may be implemented in other regions. Two participants have also been involved in disseminating aspects of this approach to clinical teaching in Ho Chi Minh, with further plans for more in-depth dissemination to occur throughout the country.

Investigating the performance of automatic new topic identification across multiple datasets 1

Recent studies on automatic new topic identification in Web search engine user sessions demonstrated that neural networks are successful in automatic new topic identification. However most of this work applied their new topic identification algorithms on data logs from a single search engine. In this study, we investigate whether the application of neural networks for automatic new topic identification are more successful on some search engines than others. Sample data logs from the Norwegian search engine FAST (currently owned by Overture) and Excite are used in this study. Findings of this study suggest that query logs with more topic shifts tend to provide more successful results on shift-based performance measures, whereas logs with more topic continuations tend to provide better results on continuation-based performance measures.

Threat appraisal for harm from falls: Insights for development of education-based intervention

Objective: This study aims to describe how patients perceive the threat of falls in hospitals, to identify patient characteristics that are associated with greater or lesser perceptions of the threat of falls, and to examine whether there is a discord between the risk that patients perceive in general and the risk that they perceive for themselves personally. Method: A cross-sectional survey amongst geriatric rehabilitation inpatients in Brisbane, Australia, was implemented. The first component of the survey dealt with the ‘general’ nature of in-hospital falls and falls related risks while the second component of the survey was directed at identifying whether the patient held the same belief for themselves. Results: A total of 21 out of 125 participants (17%) indicated that they felt that they were at risk of falling during their hospitalisation and 28 (22%) felt that they would injure themselves if they were to fall. Self-perceived risk of falls was associated with decreasing age and lower cognitive function (Functional Independence Measure Cognitive score). A majority of patients felt that falls most commonly occur in the bathroom [n=67 (54%)] and that if they were to fall, they would fall in the bathroom [n=56 (45%)]. Discussion: Patients generally do not think they are at risk of falling while in hospital and this may contribute to poor adherence to falls prevention strategies. It is possible that raising patient perception of the risk of falls and injury from falls in hospitals may help improve adherence to falls prevention strategies in this setting.

Everyone's problem but nobody's job : staff perceptions and explanations for poor nutritional intake in older medical patients

Aim: Up to 60% of older medical patients are malnourished with further decline during hospital stay. There is limited evidence for effective nutrition intervention. Staff focus groups were conducted to improve understanding of potential contextual and cultural barriers to feeding older adults in hospital. Methods: Three focus groups involved 22 staff working on the acute medical wards of a large tertiary teaching hospital. Staff disciplines were nursing, dietetics, speech pathology, occupational therapy, physiotherapy, pharmacy. A semistructured topic guide was used by the same facilitator to prompt discussions on hospital nutrition care including barriers. Focus groups were tape-recorded, transcribed and analysed thematically. Results: All staff recognised malnutrition to be an important problem in older patients during hospital stay and identified patient-level barriers to nutrition care such as non-compliance to feeding plans and hospital-level barriers including nursing staff shortages. Differences between disciplines revealed a lack of a coordinated approach, including poor knowledge of nutrition care processes, poor interdisciplinary communication, and a lack of a sense of shared responsibility/coordinated approach to nutrition care. All staff talked about competing activities at meal times and felt disempowered to prioritise nutrition in the acute medical setting. Staff agreed education and ‘extra hands’ would address most barriers but did not consider organisational change. Conclusions: Redesigning the model of care to reprioritise meal-time activities and redefine multidisciplinary roles and responsibilities would support coordinated nutrition care. However, effectiveness may also depend on hospitalwide leadership and support to empower staff and increase accountability within a team-led approach.