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.

Who am I? Developing pre-service teacher identity in a digital world

The notions of identity and teacher education have attracted considerable research over the years, revealing a strong correlation between teacher beliefs and practices and the resultant impact on pedagogical practices in the classroom. In an era where the use of digital technologies should be synonymous with teacher pedagogical practices and transforming education, there is a growing need for pre-service teachers to develop an identity that resonates with pedagogical practices that engage and connect with students in a positive and productive way. With many educational institutions also mandating that educators use digital technologies as a tool to support and enhance teaching, pre-service teacher education needs to ensure that students understand and develop a positive identity within this digital world. Current literature acknowledges that many educators adopt digital technologies in the classroom without sometimes fully understanding its scope or impact. It is within this context that this paper reports on a three-year study of first year pre-service education students and their understanding of identity in a digital world. More specifically, the study identifies how students currently use social and digital media in their personal and professional lives to identify themselves online in order to promote a positive image. The study also seeks to identify how these technologies and an understanding of identity can be utilised to promote a positive first year experience.

Factors influencing sustainability of health service innovation, emergency nurse practitioner service

Escalating health care delivery costs and consumer expectations have led to a range of health service and workforce innovations in the provision of high quality cost effective patient care. This research has operationalised a theoretical framework to examine factors that influence sustainability of health service innovations, in particular, emergency nurse practitioner service. The results of this research will inform health service policy and practice for future implementation of innovative workforce models and add to the understanding of factors that influence sustainability.

Moving from evaluation to trial: How do SMEs start adopting Cloud ERP?

The advent of cloud technology involving low subscription overheads cost has provided small and medium-sized enterprises (SMEs) with the opportunity to adopt new cloud-based corporate-wide systems (i.e., cloud ERP). This technology, operating through subscription-based services, has now provided SMEs with a complete range of IT applications that were once restricted to larger organisations. As anecdotal evidences suggest, SMEs are increasingly adopting cloud-based ERP software. The selection of an ERP is a complex process involving multiple stages and stakeholders, suggesting the importance of closer examination of cloud ERP adoption in SMEs. Yet, prior studies have predominantly treated technology adoption as a single activity and largely ignored the issue of ERP adoption in SMEs. Understanding of the process nature of the adoption and the factors that are important in each stage of the adoption potentially may result in guiding SMEs to make well-informed decisions throughout the ERP selection process. Thus, our study proposes that the adoption of cloud ERP should be examined as a multi-stage process. Using the Theory of Planned Behaviour (TPB) and Ettlie’s adoption stages, as well as employing data gathered from 162 owners of SMEs, our findings show that the factors that influence the intention to adopt cloud ERP vary significantly across adoptive stages.

Public Demand for Safer Speeds: Identification of Interventions for Trial

Speeding is a major contributor to road injuries and fatalities and remains prevalent. Changing community perceptions about speeding is an important priority. Austroads commissioned research to identify a range of potential interventions for future trial and evaluation aimed at creating, increasing, and/or sustaining public demand for safer speeds. This project had three phases: a literature review; consultations with key stakeholders regarding intervention options (including feasibility, and likely benefits and costs of identified interventions); and providing research results, including recommendations for future phases of the program of work. The literature review led to the development of a draft Campaign Strategy targeting nine aims across three themes underpinning this research: 1) creating, 2) increasing, and 3) sustaining public demand for safer speeds on the road. Twenty-one stakeholders commented on the suitability and feasibility of, and likely barriers to, countermeasures within the draft Campaign Strategy and its applicability to the Australian and New Zealand context. There was overwhelming positive support for the proposed Campaign Strategy by the majority of respondents; many, noting that it addressed key misperceptions and complemented many existing approaches. A small number of respondents expressed some concerns with various aspects. Stakeholder feedback was incorporated into the final proposed Campaign Strategy to enhance its potential effectiveness. Wide diversity across jurisdictions makes the recommendation of individual interventions for specific areas problematic. Individual jurisdictions should consider a range of costs and benefits of the proposed Campaign Strategy to determine the likely feasibility from their unique perspective. Issues to be addressed when considering implementation of the proposed Campaign Strategy include speed limit setting policies, resourcing, messaging and advertising strategies, and political will associated with promoting safer speeds.

A randomized controlled trial protocol testing a decision support intervention for older patients with advanced kidney disease

Aim To assess the effectiveness of a decision support intervention using a pragmatic single blind Randomized Controlled Trial. Background Worldwide the proportion of older people (aged 65 years and over) is rising. This population is known to have a higher prevalence of chronic diseases including chronic kidney disease. The resultant effect of the changing health landscape is seen in the increase in older patients (aged ≥65 years) commencing on dialysis. Emerging evidence suggests that for some older patients dialysis may provide minimal benefit. In a majority of renal units non-dialysis management is offered as an alternative to undertaking dialysis. Research regarding decision-making support that is required to assist this population in choosing between dialysis or non-dialysis management is limited. Design. A multisite single blinded pragmatic randomized controlled trial is proposed. Methods Patients will be recruited from four Queensland public hospitals and randomizd into either the control or intervention group. The decision support intervention is multimodal and includes counselling provided by a trained nurse. The comparator is standard decision-making support. The primary outcomes are decisional regret and decisional conflict. Secondary outcomes are improved knowledge and quality of life. Ethics approval obtained November 2014. Conclusion This is one of the first randomized controlled trials assessing a decision support intervention in older people with advance chronic kidney disease. The results may provide guidance for clinicians in future approaches to assist this population in decision-making to ensure reduced decisional regret and decisional conflict.

A randomised controlled clinical trial of a post-discharge, nurse-led educational intervention to reduce anxiety and enhance self-efficacy in percutaneous coronary intervention (PCI) patients within the first week post-discharge: A pilot study

This research investigated the efficacy of a post-discharge nurse-led clinic, for patients who underwent a cardiovascular interventional procedure in Australia. A randomised controlled clinical trial measured the effects of the clinic on patient confidence to self-manage and minimise psychological distress given the strong link between anxiety, depression and coronary heart disease. Hospitalisation for the procedure is short and stressful, and patients may wait up to 7-64 days for post-discharge review. This study provides preliminary quantitative and qualitative evidence that nurse-led clinics undertaken within the first week post-percutaneous coronary intervention may fill a much-needed gap for patients during a potentially vulnerable period.

Connecting for innovation: Four universities collaboratively preparing pre-service teachers to teach in rural and remote Western Australia

In 2010 a group of teacher educators from four universities, experienced in rural and remote education, formed the Tertiary Educators Rural, Regional and Remote Network (TERRR Network). The collaborative goal was to improve the quality of graduates taking appointments beyond the metropolitan areas of Western Australia. The TERRR Network developed a research project to improve the capacity of universities to prepare teachers for employment in rural and remote locations. A range of outcomes emerged from the project, including: 1) the development of seven rural and remote-oriented curricula modules linked to the Australian Professional Standards for Teachers; 2) a cross-institutional field experience, and; 3) the development of a community of practice involving the Department of Education, universities and schools to address the logistical implications of placing pre-service students in rural and remote locations. This paper reports on the five phases of the project design, with a focus on learning in the field and concludes with reflections on the collaborative process used by the four universities in order to ensure that research evidence informs future policy and program development.

Going bush: Preparing pre-service teachers to teach in regional Western Australia

This paper reports on outcomes of Phases One and Two of the ALTC Competitive Research and Development Project "Developing Strategies at the Pre-Service Level to Address Critical Teacher Attraction and Retention Issues in Australian Rural, Regional and Remote Schools." This project funded over two years aims to strengthen the capacity and credibility of universities to prepare rural, regional and remote educators, similar to the capacity and credibility that has been created in preparing Australia's rural, regional and remote health workers. There is a strong recognition of the fundamental importance of quality teaching experiences rural, regional and remote schools and throughout this project over 200 pre-service teachers have participated in a curriculum module/object and completed a survey that encourages them to consider teaching in regional Western Australia. The project has mapped current Western Australian rural, regional and remote pre-service teacher education curriculum and field experience model. This mapping completed a comparison of national information with the identification of rural, regional and remote education curriculum and/or field experience models used nationally and internationally. In particular results from Phase One and Two will be presented reporting on the findings of the first year of the project.

New Frontiers or old certainties: The pre-service teacher internship

Teacher education in Australia has a rich history of evolution from apprenticeships to university education. In this chapter the teacher education internship is examined. More specifically, the chapter outlines the Western Australian Combined Universities Training School (WACUTS) project, with its focus on reducing the gap between theory and practice through a collaborative and reflective approach. The successes and challenges faced in the first six months of implementation are presented

Regional resilience: Pre-service teacher preparation to teach in the bush

This paper reports on the outcomes of a two year ALTC Competitive Research and Development Project that aimed to "Develop Strategies at the Pre-Service Level to Address Critical Teacher Attraction and Retention Issues in Australian Rural, Regional and Remote Schools". As well as developing a ‘training framework’ and teaching guides to increase the capacity and credibility of four universities to prepare educators who might venture out of the metropolitan area to teach, data were gathered from pre-service and graduate teachers to analyse regional resilience. It was found that there was a strong likelihood to participate in a regional practicum and stay in a non-metropolitan community once they graduated from university if they had a positive attitude to regional Western Australia either through a family connection or previous experience. Recommendations from this study emphasise the importance of having pre-service students participate in positive regional experiences early in their university study.

See you in class: Promoting a quality program for pre-service educators in regional locations through a virtual classroom

The quality of an online university degree is paramount to the student, the reputation of the university and most importantly, the profession that will be entered. At the School of Education within Curtin University, we aim to ensure that students within rural and remote areas are provided with high quality degrees equal to their city counterparts who access face-to-face classes on campus.In 2010, the School of Education moved to flexible delivery of a fully online Bachelor of Education degree for their rural students. In previous years, the degree had been delivered in physical locations around the state. Although this served the purpose for the time, it restricted the degree to only those rural students who were able to access the physical campus. The new model in 2010 allows access for students in any rural area who have a computer and an internet connection, regardless of their geographical location. As a result enrolments have seen a positive increase in new students. Academic staff had previously used an asynchronous environment to deliver learning modules housed within a learning management system (LMS). To enhance the learning environment and to provide high quality learning experiences to students learning at a distance, the adoption of synchronous software was introduced. This software is a real-time virtual classroom environment that allows for communication through Voice over Internet Protocol (VoIP) and videoconferencing, along with a large number of collaboration tools to engage learners. This research paper reports on the professional development of academic staff to integrate a live e-learning solution into their current LMS environment. It involved professional development, including technical orientation for teaching staff and course participants simultaneously. Further, pedagogical innovations were offered to engage the students in a collaborative learning environment. Data were collected from academic staff through semi-structured interviews and participant observation. The findings discuss the perceived value of the technology, problems encountered and solutions sought.

Randomised controlled trial of three burns dressings for partial thickness burns in children

BACKGROUND This study compared the effects of three silver dressing combinations on small to medium size acute partial thickness burns in children, focusing on re-epithelialization time, pain and distress during dressing changes. METHOD Children (0-15 years) with clean, ≤ 10% total body surface area (TBSA) partial thickness burns who met the inclusion criteria were included in the study. Children received either (1) Acticoat™; (2) Acticoat™ with Mepitel™; or (3) Mepilex Ag™ dressings. Measures of burn re-epithelialization, pain, and distress were recorded at dressing changes every 3-5 days until full re-epithelialization occurred. RESULTS One hundred and three children were recruited with 96 children included for analysis. No infections were detected for the course of the study. When adjusted for burn depth, Acticoat™ significantly increased the expected days to full re-epithelialization by 40% (IRR = 1.40; 95% CI: 1.14-1.73, p < 0.01) and Acticoat™ with Mepitel™ significantly increased the expected days to full re-epithelialization by 33% (IRR = 1.33; 95% CI: 1.08-1.63, p ≤ 0.01) when compared to Mepilex Ag™. Expected FLACC scores in the Mepilex Ag™ group were 32% lower at dressing removal (p = 0.01) and 37% lower at new dressing application (p = 0.04); and scores in the Acticoat™ with Mepitel™ group were 23% lower at dressing removal (p = 0.04) and 40% lower at new dressing application (p < 0.01), in comparison to the Acticoat™ group. Expected Visual Analog Scale-Pain (VAS-P) scores were 25% lower in the Mepilex Ag™ group at dressing removal (p = 0.04) and 34% lower in the Acticoat™ with Mepitel™ group (p = 0.02) at new dressing application in comparison to the Acticoat™ group. There was no significant difference between the Mepilex Ag™ and the Acticoat™ with Mepitel™ groups at all timepoints and with any pain measure. CONCLUSION Mepilex Ag™ is an effective silver dressing, in terms of accelerated wound re-epithelialization time (compared to Acticoat™ and Acticoat™ with Mepitel™) and decreased pain during dressing changes (compared to Acticoat™), for clean, < 10% TBSA partial thickness burns in children.