Patient group directions : the application and integration of knowledge in advancing nursing practice

Background: The introduction of Patient Group Directions (PGD) has changed significantly the way in which nurses can now administer prescription only medicines as a one-off for patients requiring this level of service. PGD’s are a written authority to administer drugs to patients that are not identified at the time of treatment. Aim: The aim of this project was to develop a PGD for use within an Outreach team to administer colloid boluses to patients presenting with hypovolemia. Method: Using a case exemplar this paper will discuss the development of a PGD using aspects of transitional change theory to highlight the potential barriers that were encountered. Implications for Practice: The implications for this PGD are wide reaching. First it now enables members from the nursing Outreach team to administer colloid fluid boluses to a prescribed patient cohort without the need for prescription. Second, it ensures the deteriorating patient has interventions initiated in a timely and appropriate manner to reduce inadvertent admission to high care areas. Last, it will improve inter-professional team-working and communication so much so that collaborative patient care reduces health costs and identifies earlier those patients requiring substantially greater nursing and medical input. Conclusion: The experience of developing a working PGD for fluid administration has meant that the Outreach team is able to respond to patients in a more effective way. In addition, it is the experience of developing this PGD that has enabled the team to contemplate other PGD’s in the execution of Outreach work.

Meeting the nutrition challenge of stage 3 renal failure : considerations for nursing practice

Self-care management is needed for effective management of chronic kidney disease. The main aim for treatment or management of chronic kidney disease is to delay the worsening of kidney function, and to prevent or to manage the co-morbidities. Selfcare management is not easy, and patients will face many challenges, especially when they cannot get use to the new treatment plan. One of the challenges they face is dietary restriction, which is a very important aspect in any self-care management programme. Chronic kidney disease patients require a low-protein, low-sodium, low-potassium, and low-phosphorus diet. There are several strategies patients can undertake to ensure adherence, such as self-monitoring their dietary habits and type of food consumed using a food diary; involving social support, such as family members and spouse to help them to adhere to their diet restrictions; setting goals and providing positive reinforcement when they achieved the targeted goals; joining self-management programmes to equip themselves with the necessary skills so that they can better adhere to the treatment regimes, including diet restriction; and lastly, having the knowledge about their regime, and using this knowledge to help them understand and improve their adherence.

The pathophysiology of ischaemic stroke : considerations for emergency department advanced practice nursing

Stroke is the fourth most important cause of death in Singapore. Its major predisposing factors include hypertension, type 2 diabetes mellitus and hyperlipidaemia; all modifiable diseases if treated early. However, with Singapore’s elderly population, the risk and rates of stroke are ever increasing. The nature of a stroke can be categorised as eitherh aemorrhagic or ischaemic; the former caused by arterial rupture, the latter by arterial blockage; both can be devastating in their prognosis and outcome. This paper will discuss the pathophysiology of ischaemic stroke while identifying some of the key features of ischaemia on different areas of the brain relative to the artery that feeds them. Thoughts for Emergency Department advanced practice nursing will also be discussed.

Alarm setting for the critically ill patient : A descriptive pilot survey of nurses’ perceptions of current practice in an Australian Regional Critical Care Unit

Aim: The aim of this survey was to assess registered nurse’s perceptions of alarm setting and management in an Australian Regional Critical Care Unit. Background: The setting and management of alarms within the critical care environment is one of the key responsibilities of the nurse in this area. However, with up to 99% of alarms potentially being false-positives it is easy for the nurse to become desensitised or fatigued by incessant alarms; in some cases up to 400 per patient per day. Inadvertently ignoring, silencing or disabling alarms can have deleterious implications for the patient and nurse. Method: A total population sample of 48 nursing staff from a 13 bedded ICU/HDU/CCU within regional Australia were asked to participate. A 10 item open-ended and multiple choice questionnaire was distributed to determine their perceptions and attitudes of alarm setting and management within this clinical area. Results: Two key themes were identified from the open-ended questions: attitudes towards inappropriate alarm settings and annoyance at delayed responses to alarms. A significant number of respondents (93%) agreed that alarm fatigue can result in alarm desensitisation and the disabling of alarms, whilst 81% suggested the key factors are those associated with false-positive alarms and inappropriately set alarms.

The Australian practice pharmacist

Background: Evolution in Australian community pharmacy and general practice environments has seen the emergence of a new opportunity for pharmacist practice, distinct from the conventional community and hospital settings, in which the pharmacist is integrated into the general practice setting to provide professional services. Aim: To characterise pharmacists practising in the Australian general practice setting. Method: An electronic questionnaire. Results: Twenty-six practice pharmacists completed the questionnaire. Practice pharmacists were more likely to be female, aged between 30 and 49 years, have postgraduate qualifications and also work in other pharmacy sectors. The general practice settings more frequently had multiple general practitioners and also housed multiple allied health professionals. The most commonly conducted services provided by the practice pharmacists were Home Medicine Reviews, responding to clinical enquiries from general practitioners and responding to enquiries from other health professionals. Most practice pharmacists worked as independent contractors for services provided. The practice pharmacists provided some services in the absence of remuneration. The majority of practice pharmacists agreed or strongly agreed that a set of competencies should be developed and a credentialing process required with experience of the pharmacist being regarded highly. Conclusion: The results of this study have described the variety of professional roles, remuneration and characteristics in a small sample of pharmacists practising in a general practice setting in Australia. For this model of pharmacist practice to expand an appropriate method of remuneration is required.

Intercultural Dialogues in Early Childhood Education for Sustainability : Embedding Indigenous Perspectives

Embedding Indigenous perspectives in early childhood education for sustainability (ECEfS) upholds social and political action goals that support a holistic approach to promoting sustainability in educational contexts. Such goals should be responsive to particular contexts and their histories to ensure local issues are a focus of sustainability alongside global areas of concern. This chapter explores how intercultural dialogues and priorities foreground broader themes of sustainability that attend to local issues around culture and diversity, and equity in relations between groups of people. Attending to such themes in educational practice unsettles a standard environmental narrative and broadens the scope and potential for ECEfS in early years settings. Strengthening intercultural priorities in ECEfS requires a commitment to reflective practices that attend to the influence of one's cultural background on teaching and learning processes. Educators committed to reflective practices provide even greater capacity for children to act as change agents (Davis, 2008, 2010) around multiple dimensions of sustainability.

Trashtopia by Maison Briz Vegas

Description of the Work Trashtopia was a fashion exhibition at Craft Queensland’s Artisan gallery showcasing outfits made entirely from rubbish materials. The exhibition was part of an on-going series by the Queensland Fashion Archives, called Remember or Revive. Maison Briz Vegas designers, Carla Binotto and Carla van Lunn created a dystopian beach holiday tableau referencing mid-century Californian and Gold Coast beach culture and style, and today’s plastic pollution of the world’s oceans. The display engaged a popular audience with ideas about environmental destruction and climate change while bringing twentieth and twenty-first century consumer and leisure culture into question. The medium of fashion was used as a means of amusement and provocation. The fashion objects and installation questioned current mores about the material value of rubbish and the installation was also a work of environmental activism. Statement of the Research Component The work was framed by critical reflections of contemporary consumer culture and research fields questioning value in waste materials and fashion objects. The work is situated in the context of conceptual and experimental fashion design practice and fashion presentation. The exhibited work transgressed the conventional production methods and material choice of designer fashion garments, for example, discarded plastic shopping bags were painstakingly shredded to mimic ostrich feathers. The viewer was prompted to reflect on the materiality of rubbish and its potential for transformation. The exhibition also sits in the context of culture jamming and contemporary activist practice. The work references and subverts twentieth century beach holiday culture, contrasting resort wear with a contemporary picture of plastic pollution of the oceans and climate change. Hawaiian style prints contained a playful and dark narrative of dying marine-life and the viewer was invited to take a “Greetings from Trashtopia” postcard depicting fashion models floating in oceans of plastic rubbish. This reflective creative practice sought to address the question of whether fashion made from recycled rubbish materials can critically and emotionally engage viewers with questions about contemporary consumer culture and material value. This work presents an innovative model of fashion design practice in which rubbish materials are transformed into designer garments and rubbish is placed centre stage in the public presentation of the designs. In overturning the traditional model of fashion presentation, the viewer is also given a deeper connection to the recycling process and complex ideas of waste and value. In 2015 two outfits from the exhibition were selected, along with works from three leading Australian fashion labels, and four leading New Zealand labels, for a commemorative ANZAC fashion collection shown at iD Dunedin Fashion Week. The show titled, “Together Alone, revisited” reprised an Australian and New Zealand fashion exhibition first held at the National Gallery of Victoria in 2009.

Beyond competencies : using a capability framework in developing practice standards for advanced practice nursing

AIM This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies. BACKGROUND There is acceptance that competencies are useful and necessary for definition and education of practice-based professions. Competencies have been described as appropriate for practice in stable environments with familiar problems. Increasingly competencies are being designed for use in the health sector for advanced practice such as the nurse practitioner role. Nurse practitioners work in environments and roles that are dynamic and unpredictable necessitating attributes and skills to practice at advanced and extended levels in both familiar and unfamiliar clinical situations. Capability has been described as the combination of skills, knowledge, values and self-esteem which enables individuals to manage change, be flexible and move beyond competency. DESIGN A discussion paper exploring 'capability' as a framework for advanced nursing practice standards. DATA SOURCES Data were sourced from electronic databases as described in the background section. IMPLICATIONS FOR NURSING As advanced practice nursing becomes more established and formalized, novel ways of teaching and assessing the practice of experienced clinicians beyond competency are imperative for the changing context of health services. CONCLUSION Leading researchers into capability in health care state that traditional education and training in health disciplines concentrates mainly on developing competence. To ensure that healthcare delivery keeps pace with increasing demand and a continuously changing context there is a need to embrace capability as a framework for advanced practice and education.

A stakeholder analysis of one institution’s assuring learning experience – is the promise and the practice worth the price?

Universities around the world are rushing to implement assurance of learning policies and practices with varying degrees of success. One School investigated its own policy and practice development through the eyes of its key stakeholders to identify whether the practice was worth the price. Findings indicate that although the key stakeholders considered different needs and viewed their experiences differently, value did abound and was in the eye of the beholder.

Making stories matter: Using participatory new media storytelling and evaluation to serve marginalised and regional communities

In this chapter, we draw on our experiences facilitating community storytelling workshops in regional Queensland in partnership with the Queensland branch of Oral History Association of Australia (OHAA Qld) in order to develop a best practice model for promoting creative approaches to recording oral narratives using digital tools, informed by creative writing practice and embedded evaluation (Klaebe 2012 & 2013). These experiences offer an insight into how creative approaches to training can facilitate the sharing and preservation of stories in regional communities.

Strategies for teaching evidence-based practice to undergraduate health students: A systematic review protocol

Review question/objective The objective of this review is to find, critically appraise and synthesize the available quantitative evidence on the effectiveness of interventions that promote successful teaching of the evidence-based practice process in undergraduate health students, in preparation for them to become professional evidence-based practitioners. More specifically, the question that this review seeks to answer is: What is the effectiveness of teaching strategies for evidence-based practice for undergraduate health students? Inclusion criteria Types of participants This review will consider studies that include undergraduate health students from any undergraduate health discipline, including but not limited to medicine, nursing and allied health. Post graduate and post-registration students will not be included. Types of interventions This review will consider studies that evaluate strategies or interventions aimed at teaching any or all of the five steps of evidence-based practice, namely asking a structured clinical question; collecting the best evidence available; critically appraising the evidence to ensure validity, relevance and applicability; applying or integrating the results into clinical practice, and evaluating outcomes. The strategy may take place solely within a tertiary education environment or may be combined with a clinical setting. Types of outcomes This review will consider studies that include the following outcome measures: evidence-based practice behavior, knowledge, skills, attitudes, self-efficacy (or self-confidence), beliefs, values, intention to use evidence-based practice (future use) and confidence levels. Tools used to measure these outcomes will be assessed for reported validity, reliability and generalizability. Outcomes will be measured during the student’s education period up to graduation. If studies are conducted across different year levels this will be taken into account during analysis and reported accordingly.