Providing 'best practice' placements begins with mentoring skills : overview of the Program of Experience in the Palliative Approach (PEPA) quality improvement initiatives for mentors

Objectives PEPA is funded by the Department of Health and Ageing and aims to further improve the skill and confidence of the generalist workforce to work with people with palliative care needs. Recent quality improvement initiatives to promote transfer of learning into practice include appointment of a clinical educator, implementation of an online module for mentors and delivery of a mentoring workshop (collaborating with NSAP and PCC4U). This paper presents an overview of outcomes from these quality improvement initiatives. Methods PEPA host sites are selected based on their specialist palliative care level. Host site managers are surveyed six-monthly and participants are surveyed pre and three months post-placement to collect open and fixed response data on their experience of the program. Participants in the mentoring workshop (n=39) were asked to respond to a survey regarding the workshop outcomes. Results The percentage of placement participants who strongly agreed they ‘have the ability to implement the interventions required for people who have a life-limiting illness’ increased from 35% in 2011 (n=34) to 51% in 2012 (n=91) post-placement. Responses from mentor workshop participants indicated that 76% of respondents (n=25) agreed that they were able to identify principles for mentoring in the context of palliative care. In 2012, 61% of host site managers (n=54) strongly agreed that PEPA supports clinician working with people with a life-limiting illness. Conclusion Strategies to build the capabilities of palliative care professionals to mentor and support the learning experience of PEPA participants are critical to ongoing improvements of the program.

Pharmacist, general practitioner, and nurse perceptions, experiences, and knowledge of medication dosage form modification

Background: People often modify oral solid dosage forms when they experience difficulty swallowing them. Modifying dosage forms may cause adverse effects to the patient, and the person undertaking the modification. Pharmacists are often the first point of contact for people in the general community seeking advice regarding medications. Nurses are at the forefront of administering medications to patients and are likely to be most directly affected by a patient’s swallowing ability, while general practitioners (GPs) are expected to consider swallowing abilities when prescribing medications. Objective: To compare the perspectives and experiences of GPs, pharmacists, and nurses regarding medication dosage form modification and their knowledge of medication modification. Method: Questionnaires tailored to each profession were posted to 630 GPs, and links to an online version were distributed to 2,090 pharmacists and 505 nurses. Results: When compared to pharmacists and GPs, nurses perceived that a greater proportion of the general community modified solid dosage forms. Pharmacists and GPs were most likely to consider allergies and medical history when deciding whether to prescribe or dispense a medicine, while nurses’ priorities were allergies and swallowing problems when administering medications. While nurses were more likely to ask their patients about their ability to swallow medications, most health professionals reported that patients “rarely” or “never” volunteered information about swallowing difficulties. The majority of health professionals would advise a patient to crush or split noncoated non-sustained-release tablets, and would consult colleagues or reference sources for sustained-release or coated tablets. Health professionals appeared to rely heavily upon the suffix attached to medication names (which suggest modified release properties) to identify potential problems associated with modifying medications. Conclusion: The different professional roles and responsibilities of GPs, pharmacists, and nurses are associated with different perspectives of, and experiences with, people modifying medications in the general community and knowledge about consequences of medication modification.

12 principles for the effective supervision of creative practice higher research degrees, dispatches from the field

In late 2012 and early 2013 we interviewed 25 experienced and early career supervisors of creative practice higher research degrees. This journey spanned five universities and a broad range of disciplines including visual art, music, performing art, new media, creative writing, fashion, graphic design, interaction design and interior design. Some of the supervisors we interviewed were amongst the first to complete and supervise practice-led and practice-based PhDs; some have advocated for and defined this emergent field; and some belong to the next generation of supervisors who have confidently embarked on this exciting and challenging path. Their reflections have brought to light many insights gained over the past decade. Here we have drawn together common themes into a collection of principles and best practice examples. We present them as advice rather than rules, as one thing that the supervisors were unanimous about is the need to avoid proscriptive models and frameworks, and to foster creativity and innovation in what is still an emergent field of postgraduate supervision. It is with thanks to all of the supervisors who contributed to these conversations, and their generosity in sharing their practices, that we present their advice, exemplars and case studies.

Implementing open licensing in government open data initiatives : a review of Australian government practice

As support grows for greater access to information and data held by governments, so does awareness of the need for appropriate policy, technical and legal frameworks to achieve the desired economic and societal outcomes. Since the late 2000s numerous international organizations, inter-governmental bodies and governments have issued open government data policies, which set out key principles underpinning access to, and the release and reuse of data. These policies reiterate the value of government data and establish the default position that it should be openly accessible to the public under transparent and non-discriminatory conditions, which are conducive to innovative reuse of the data. A key principle stated in open government data policies is that legal rights in government information must be exercised in a manner that is consistent with and supports the open accessibility and reusability of the data. In particular, where government information and data is protected by copyright, access should be provided under licensing terms which clearly permit its reuse and dissemination. This principle has been further developed in the policies issued by Australian Governments into a specific requirement that Government agencies are to apply the Creative Commons Attribution licence (CC BY) as the default licensing position when releasing government information and data. A wide-ranging survey of the practices of Australian Government agencies in managing their information and data, commissioned by the Office of the Australian Information Commissioner in 2012, provides valuable insights into progress towards the achievement of open government policy objectives and the adoption of open licensing practices. The survey results indicate that Australian Government agencies are embracing open access and a proactive disclosure culture and that open licensing under Creative Commons licences is increasingly prevalent. However, the finding that ‘[t]he default position of open access licensing is not clearly or robustly stated, nor properly reflected in the practice of Government agencies’ points to the need to further develop the policy framework and the principles governing information access and reuse, and to provide practical guidance tools on open licensing if the broadest range of government information and data is to be made available for innovative reuse.

‘Crack in the pavement’ : pedagogy as political and moral practice for educating culturally competent professionals

This paper explores the reception of Indigenous perspectives and knowledges in university curricula and educators’ social responsibility to demonstrate cultural competency through their teaching and learning practices. Drawing on tenets of critical race theory, Indigenous standpoint theory and critical pedagogies, this paper argues that the existence of Indigenous knowledges in Australian university curricula and pedagogy demands personal and political activism (Dei, 2008) as it requires educators to critique both personal and discipline-based knowledge systems. The paper interrogates the experiences of non-Indigenous educators involved in this contested epistemological space (Nakata, 2002), and concludes by arguing for a political and ethical commitment by educators towards embedding Indigenous knowledges towards educating culturally competent professionals.

What is the evidence to guide best practice for the management of older people with cognitive impairment presenting to emergency departments? A systematic review

The aim of this study was to conduct a systematic literature review of research-based studies to identify practices designed to meet the specific care needs of older cognitively impaired patients in emergency departments (ED). A systematic literature review of studies was completed using PRIMSA methodology. The search criteria included articles from both emergency and acute care settings. A total of 944 articles were screened, and a total of 43 articles were identified as eligible. The review found a number of intervention studies to improve quality of care for older persons with cognitive impairment carried out or commenced in emergency settings, including interventions to improve cognitive impairment recognition (n = 9) and clinical approaches to reduce falls (n = 1) and both delirium incidence and prevalence (n = 2). Relevant studies carried out in acute care settings regarding cognitive impairment recognition (n = 4) and primary and secondary prevention of delirium (n = 18) and intervention studies that reduced the prescription of deliriogenic drugs (n = 1), reduced behavioral symptoms and discomfort (n = 7), and improved nutritional intake (n = 1) in hospitalized older persons with dementia were also identified. There is limited research available that reports interventions that improve the quality of care of older ED patients with cognitive impairment. Although this review found evidence obtained from the acute care setting, additional research is needed to identify whether these interventions are beneficial in fast-paced emergency settings.

But what makes it doctoral? Taking on the traditionalists : interdisciplinary, practice-led doctoral research in the creative industries - a case study in academic politics, research, rigour and relevance

This paper examines a Doctoral journey of interdisciplinary exploration, explication, examination...and exasperation. In choosing to pursue a practice-led doctorate I had determined from the outset that ‘writing 100,000 words that only two people ever read’, was not something which interested me. Hence, the oft-asked question of ‘what kind of doctorate’ I was engaged in, consistently elicited the response, “a useful one”. In order to satisfy my own imperatives of authenticity and usefulness, my doctoral research had to clearly demonstrate relevance to; productively inform; engage with; and add value to: wider professional field(s) of practice; students in the university courses I teach; and the broader community - not just the academic community. Consequently, over the course of my research, the question, ‘But what makes it Doctoral?’ consistently resounded and resonated. Answering that question, to satisfy not only the traditionalists asking it but, perhaps surprisingly, some academic innovators - and more particularly, myself as researcher - revealed academic/political inconsistencies and issues which challenged both the fundamental assumptions and actuality of practice-led research. This paper examines some of those inconsistencies, issues and challenges and provides at least one possible answer to the question: ‘But what makes it Doctoral?’

Dietetic practice by Australian and Canadian dietitians with people with Parkinson's disease

Although Parkinson’s disease (PD) is a complex disease for which appropriate nutrition management is important, limited evidence is currently available to support dietetic practice. Existing PD-specific guidelines do not span all phases of the Nutrition Care Process (NCP). This study aimed to document PD-specific nutrition management practice by Australian and Canadian dietitians. DAA members and PEN subscribers were invited to participate in an online survey (late 2011). Eighty-four dietitians responded (79.8% Australian). The majority (70.2%) worked in the clinical setting. Existing non-PD guidelines were used by 52.4% while 53.6% relied on self-initiated literature reviews. Weight loss/malnutrition, protein intake, dysphagia and constipation were common issues in all NCP phases. Respondents also requested more information/evidence for these topics. Malnutrition screening (82.1%) and assessment (85.7%) were routinely performed. One-third did not receive referrals for weight loss for overweight/obesity. Protein intake meeting gender/age recommendations (69.0%), and high energy/high protein diets to manage malnutrition (82.1%) were most commonly used. Constipation management was through high fibre diets (86.9%). Recommendations for spacing of meals and PD medications varied with 34.5% not making recommendations. Nutritional diagnosis (70.2%) and stage of disease (61.9%) guided monitoring frequency. Common outcome measures included appropriate weight change (97.6%) and regular bowel movements (88.1%). With limited PD-specific guidance, dietitians applied best available evidence for other groups with similar issues. Dietitians requested evidence-based guidelines specifically for the nutritional management of PD. Guideline development should focus on those areas reported as commonly encountered. This process can identify the gaps in evidence to guide future research.

CPD : Using evidence based clinical practice guidelines in the management of anaemia in patients with chronic renal failure

Anaemia is a chronic problem in patients with renal insufficiency, especially chronic renal failure (CRF). In patients with CRF, anaemia is primarily due to a deficiency in erythropoietin (EPO), a glycoprotein growth factor that stimulates RBC production. The long-term effects and burden of anaemia for patients with CRF can be physical, emotional and financial. With efficient, systematic management of anaemia, clinicians have the potential to realise not only better clinical outcomes for CRF patients but also significant cost savings for them and the health system. During the last decade, significant advances have been made in clinicians’ understanding of how best to manage anaemia in this vulnerable population. One of the most important efforts to improve clinical practice has been the development of best practice guidelines.

'I wouldn't say that' : finding a young adult, female voice in a Queensland mining town

This is a practice-led project consisting of a Young Adult novel, Open Cut, and an exegesis, 'I Wouldn't Say That': Finding a Young Adult, Female Voice in a Queensland Mining Town. The thesis investigates the use of first person narration in order to create an immediate engaging, realist Young Adult Fiction. The research design is bound by a feminist interpretative paradigm. The methodology employed is practice-led, auto-ethnography, and participant observation. Particular characteristics of first person narration used in Australian Young Adult Fiction are identified in an analysis of Dust, by Christine Bongers, and Jasper Jones, by Craig Silvey. The exegesis also contains a reflection on the researcher's creative work, and the process used to draft, edit, plot and construct the novel. The research contributes to knowledge in the field of Young Adult Literature because it offers a graphic portrayal of an Australian mining town that has not been heard before.

Point-to-point speed enforcement : recommendations for better practice

Point-to-point speed cameras are a relatively new and innovative technological approach to speed enforcement that is increasingly been used in a number of highly motorised countries. Previous research has provided evidence of the positive impact of this approach on vehicle speeds and crash rates, as well as additional traffic related outcomes such as vehicle emissions and traffic flow. This paper reports on the conclusions and recommendations of a large-scale project involving extensive consultation with international and domestic (Australian) stakeholders to explore the technological, operational, and legislative characteristics associated with the technology. More specifically, this paper provides a number of recommendations for better practice regarding the implementation of point-to-point speed enforcement in the Australian and New Zealand context. The broader implications of the research, as well as directions for future research, are also discussed.

Early childhood Australia's Best of Sustainability : Research, Practice and Theory

ECA Best of Sustainability: Research, theory and practice by Elliott, Edwards, Davis and Cutter-MacKenzie collates a range of key articles focussing on sustainability from past editions of the Australasian Journal of Early Childhood and Every Child. Sustainable service operation and promoting children’s responsibility and care for the environment are now part of the National Quality Standards and more importantly, all early childhood services must engage with sustainability in this time of increasing global environmental concerns. The publication documents the best of research, theory and practice to date and questions where has early childhood education for sustainability come from and more importantly, where is it going? There are multiple possibilities for educators, researchers, policy makers and managers to take action in early childhood settings for an environmentally sustainable future.

Do look now : re-imagining and re-purposing audiovisual creative practice

The appropriation and elaborate re-working of mediated images and sound stand in a fluid relationship with established notions such as creativity, originality and artistic freedom. The evocative, recontextualised montage works of the eminent video artists Christian Marclay (The Clock) and Tracey Moffatt (Other; Love) may be viewed critically in the light of several theorists’ work, such as Walter Benjamin’s ideas on the crisis of reproduction and reactivation. The ironic pastiche, Do Look Now, a recent video installation work, is presented here as a similar dialogical intervention, representing a subversive deconstruction and critique of filmic codes and conventions, as well as being a new work crafted out of old film clips. (The films quoted in the work are listed here in an Appendix). These practical provocations are framed within a renewed, ‘queering’ investigation of creative works. Such an exploration is, arguably, both illuminating and liberating for particular practitioners and researchers engaged with the unpredictable intersections of creative meaning-making in a heavily legalised, mediated and digitised world.

Implications of comorbidity for clinical practice

In the past, people with comorbidity have often received inadequate care. The ethical principle of equal access to quality services has important implications for agencies, when combined with knowledge about comorbidity and its management, and about diffusion of innovations across organizations. Comorbidity is common, and often has profound impacts on individuals and families. Tobacco smoking in particular is endemic and affects morbidity, mortality, and functioning. This implies that screening for co-occurring problems should be routine, and that a boutique comorbidity service is impractical. Large numbers mean that universal screening and intervention must be capable of large-scale implementation. Since multiple, closely linked problems are often present, treatments should address these multiple issues, and closely interrelated problems will require well-integrated treatment. Involvement of a single health agency is typically needed. Numbers and severity of problems can blind practitioners and patients to strengths and unaffected areas; these should be assessed and fostered. Better policies and practices for co-occurring disorders will require organizational change. Co-occurring disorders must become core business for organizations and practitioners, so that effective comorbidity practice is rewarded, required skills are present or taught, cues to use the practices are provided, and a culture supporting their application is established.