Testing the effectiveness of a Practice Development intervention on changing the culture of evidence based practice in an acute care environment

In this age of evidence-based practice, nurses are increasingly expected to use research evidence in a systematic and judicious way when making decisions about patient care practices. Clinicians recognise the role of research when it provides valid, realistic answers in practical situations. Nonetheless, research is still perceived by some nurses as external to practice and implementing research findings into practice is often difficult. Since its conceptual platform in the 1960s, the emergence and growth of Nursing Development Units, and later, Practice Development Units has been described in the literature as strategic, organisational vehicles for changing the way nurses think about nursing by promoting and supporting a culture of inquiry and research-based practice. Thus, some scholars argue that practice development is situated in the gap between research and practice. Since the 1990s, the discourse has shifted from the structure and outcomes of developing practice to the process of developing practice, using a Practice Development methodology; underpinned by critical social science theory, as a vehicle for changing the culture and context of care. The nursing and practice development literature is dominated by descriptive reports of local practice development activity, typically focusing on reflection on processes or outcomes of processes, and describing perceived benefits. However, despite the volume of published literature, there is little published empirical research in the Australian or international context on the effectiveness of Practice Development as a methodology for changing the culture and context of care - leaving a gap in the literature. The aim of this study was to develop, implement and evaluate the effectiveness of a Practice Development model for clinical practice review and change on changing the culture and context of care for nurses working in an acute care setting. A longitudinal, pre-test/post-test, non-equivalent control group design was used to answer the following research questions: 1. Is there a relationship between nurses' perceptions of the culture and context of care and nurses' perceptions of research and evidence-based practice? 2. Is there a relationship between engagement in a facilitated process of Practice Development and change in nurses' perceptions of the culture and context of care? 3. Is there a relationship between engagement in a facilitated process of Practice Development and change in nurses' perceptions of research and evidence-based practice? Through a critical analysis of the literature and synthesis of the findings of past evaluations of Nursing and Practice Development structures and processes, this research has identified key attributes consistent throughout the chronological and theoretical development of Nursing and Practice Development that exemplify a culture and context of care that is conducive to creating a culture of inquiry and evidence-based practice. The study findings were then used in the development, validation and testing of an instrument to measure change in the culture and context of care. Furthermore, this research has also provided empirical evidence of the relationship of the key attributes to each other and to barriers to research and evidence-based practice. The research also provides empirical evidence regarding the effectiveness of a Practice Development methodology in changing the culture and context of care. This research is noteworthy in its contribution to advancing the discipline of nursing by providing evidence of the degree to which attributes of the culture and context of care, namely autonomy and control, workplace empowerment and constructive team dynamics, can be connected to engagement with research and evidence-based practice.

The creative sector in New Zealand : mapping and economic role : report to New Zealand Trade and Enterprise

The New Zealand creative sector was responsible for almost 121,000 jobs at the time of the 2006 Census (6.3% of total employment). These are divided between • 35,751 creative specialists – persons employed doing creative work in creative industries • 42,300 support workers - persons providing management and support services in creative industries • 42,792 embedded creative workers – persons engaged in creative work in other types of enterprise The most striking feature of this breakdown is the fact that the largest group of creative workers are employed outside the creative industries, i.e. in other types of businesses. Even within the creative industries, there are fewer people directly engaged in creative work than in providing management and support. Creative sector employees earned incomes of approximately $52,000 per annum at the time of the 2006 Census. This is relatively uniform across all three types of creative worker, and is significantly above the average for all employed persons (of approximately $40,700). Creative employment and incomes were growing strongly over both five year periods between the 1996, 2001 and 2006 Censuses. However, when we compare creative and general trends, we see two distinct phases in the development of the creative sector: • rapid structural growth over the five years to 2001 (especially led by developments in ICT), with creative employment and incomes increasing rapidly at a time when they were growing modestly across the whole economy; • subsequent consolidation, with growth driven by more by national economic expansion than structural change, and creative employment and incomes moving in parallel with strong economy-wide growth. Other important trends revealed by the data are that • the strongest growth during the decade was in embedded creative workers, especially over the first five years. The weakest growth was in creative specialists, with support workers in creative industries in the middle rank, • by far the strongest growth in creative industries’ employment was in Software & digital content, which trebled in size over the decade Comparing New Zealand with the United Kingdom and Australia, the two southern hemisphere nations have significantly lower proportions of total employment in the creative sector (both in creative industries and embedded employment). New Zealand’s and Australia’s creative shares in 2001 were similar (5.4% each), but in the following five years, our share has expanded (to 5.7%) whereas Australia’s fell slightly (to 5.2%) – in both cases, through changes in creative industries’ employment. The creative industries generated $10.5 billion in total gross output in the March 2006 year. Resulting from this was value added totalling $5.1b, representing 3.3% of New Zealand’s total GDP. Overall, value added in the creative industries represents 49% of industry gross output, which is higher than the average across the whole economy, 45%. This is a reflection of the relatively high labour intensity and high earnings of the creative industries. Industries which have an above-average ratio of value added to gross output are usually labour-intensive, especially when wages and salaries are above average. This is true for Software & Digital Content and Architecture, Design & Visual Arts, with ratios of 60.4% and 55.2% respectively. However there is significant variation in this ratio between different parts of the creative industries, with some parts (e.g. Software & Digital Content and Architecture, Design & Visual Arts) generating even higher value added relative to output, and others (e.g. TV & Radio, Publishing and Music & Performing Arts) less, because of high capital intensity and import content. When we take into account the impact of the creative industries’ demand for goods and services from its suppliers and consumption spending from incomes earned, we estimate that there is an addition to economic activity of: • $30.9 billion in gross output, $41.4b in total • $15.1b in value added, $20.3b in total • 158,100 people employed, 234,600 in total The total economic impact of the creative industries is approximately four times their direct output and value added, and three times their direct employment. Their effect on output and value added is roughly in line with the average over all industries, although the effect on employment is significantly lower. This is because of the relatively high labour intensity (and high earnings) of the creative industries, which generate below-average demand from suppliers, but normal levels of demand though expenditure from incomes. Drawing on these numbers and conclusions, we suggest some (slightly speculative) directions for future research. The goal is to better understand the contribution the creative sector makes to productivity growth; in particular, the distinctive contributions from creative firms and embedded creative workers. The ideas for future research can be organised into the several categories: • Understanding the categories of the creative sector– who is doing the business? In other words, examine via more fine grained research (at a firm level perhaps) just what is the creative contribution from the different aspects of the creative sector industries. It may be possible to categorise these in terms of more or less striking innovations. • Investigate the relationship between the characteristics and the performance of the various creative industries/ sectors; • Look more closely at innovation at an industry level e.g. using an index of relative growth of exports, and see if this can be related to intensity of use of creative inputs; • Undertake case studies of the creative sector; • Undertake case studies of the embedded contribution to growth in the firms and industries that employ them, by examining taking several high performing noncreative industries (in the same way as proposed for the creative sector). • Look at the aggregates – drawing on the broad picture of the extent of the numbers of creative workers embedded within the different industries, consider the extent to which these might explain aspects of the industries’ varied performance in terms of exports, growth and so on. • This might be able to extended to examine issues like the type of creative workers that are most effective when embedded, or test the hypothesis that each industry has its own particular requirements for embedded creative workers that overwhelms any generic contributions from say design, or IT.

Power system stability analysis based on descriptive study of electrical indices

In a power network, when a propagation energy wave caused by a disturbance hits a weak link, a reflection is appeared and some of energy is transferred across the link. In this work, an analytical descriptive methodology is proposed to study the dynamical stability of a large scale power system. For this purpose, the measured electrical indices (angle, or voltage/frequency) following a fault in different points among the network are used, and the behaviors of the propagated waves through the lines, nodes and buses are studied. This work addresses a new tool for power system stability analysis based on a descriptive study of electrical measurements. The proposed methodology is also useful to detect the contingency condition and synthesis of an effective emergency control scheme.

Lighter than Tai

YEAR: 2008 ROLE: Performer FORMAT: Live Art Event at Tiananmen Square Beijing, China (3 hours) and Later on Summit of Mt. Tai Shan, Shandong Province, China (6 hrs + 3 hrs). WITH: Solo WHAT: In the Hall of Reverence on Tiananmen Square, Beijing Mao Zedong's body lies in state surrounded by flowers and draped with a Red Flag of Communist China. His casket with a glass top lies on a black stone from Mt. Tai, reflecting the quotation from Sima Qian (China's Han Dynasty historian) that "One's life can be weightier than Mt. Tai or lighter than a goose feather". This pair of performances were a quiet, personal reflection upon what such a once revolutionary expression might mean in today's very different time and place. The work was conceived during the Olympic Cultural Festival showing of Intimate Transactions (www.intimatetransactions.com) - during the tumultuous times leading up to China's proudly staged August 2008 Olympics. The rise and rise of China had long been generating major geopolitical, ecological and cross-cultural shifts throughout the region and beyond. In this dramatic epicentre of change and at a time of such great national pride, how might we each act in ways that are ecologically 'mighty' and yet simultaneously have an impact lighter than a goosefeather? This is both a question for China in its relations with the autonomous provinces and the environment as it is for all of us in our own 'local' affairs. However ecologically speaking all that is of local concern is of global concern and noone can therefore be exempt from the need to sustain that which we share in common and must all protect for the future. Performance 1: Tiananmen Square, Beijing: Dropping 100 goose feathers. Performance 2: The summit of Mt Tai, Shandong Province. Building a mountain from Goose Feathers. SHOWING HISTORY: 1: Anniversary of Protest Crackdown, Jun 8th 2008. 2: Dawn on Tai Shan's summit, 15th June, 2008 DETAILS: Performance 1: Begin an hour after dawn (5.45am) in Tiananmen Square Bring pre-prepared performance shirt, a bag of goose feathers tipped with red. Begin at the "Gate of Heavenly Peace" under the image of Chairman Mao. Circumnavigate the world's largest open and the most surveilled public space 5 times dropping feathers periodically. Meditate on Forces of Change. Finally enter Chairman Mao's mausoleum with the masses and move quietly past his preserved body. End the performance at the Gate of Heavenly Peace 3 hours later. Performance 2: Walk up Mt. Tai Shan in silence meditating on Forces of Change (6 hours). Stay overnight on the summit. Begin an hour before dawn (3.45am) in silence. Bring performance shirt, a sack of goose feathers and a simple wooden structure. On the sunrise viewing side of the mountain build a miniature, fragile 'mountain' in goose feathers and sticks on the edge of a sheer precipice. Watch the sun rise as the feathers blow away into the valley deep below (3 hours).

Assessment of online discussion forums for law students

This paper goes beyond the existing literature and explores the innovative topic of designing criterion-referenced assessment for online discussion forums. There are several benefits of embedding online discussion forums into subjects including engaging students in collaborative learning, and encouraging deeper analysis, critical thinking and reflection. Using the assessment principles of validity, reliability and transparency, this paper offers a range of practical strategies to tutors who plan to develop criterion-referenced assessment as opposed to norm-referenced assessment for online discussion forums, applies the assessment principles in the context of an undergraduate law subject, and exemplars a rubric for an online discussion forum in a work placement subject.

What are students' understandings of how digital tools contribute to learning in design disciplines?

Building Information Modelling (BIM) is evolving in the Construction Industry as a successor to CAD. CAD is mostly a technical tool that conforms to existing industry practices, however BIM has the capacity to revolutionise industry practice. Rather than producing representations of design intent, BIM produces an exact Virtual Prototype of any building that in an ideal situation is centrally stored and freely exchanged between the project team, facilitating collaboration and allowing experimentation in design. Exposing design students to this technology through their formal studies allows them to engage with cutting edge industry practices and to help shape the industry upon their graduation. Since this technology is relatively new to the construction industry, there are no accepted models for how to “teach” BIM effectively at university level. Developing learning models to enable students to make the most out of their learning with BIM presents significant challenges to those teaching in the field of design. To date there are also no studies of students experiences of using this technology. This research reports on the introduction of Building Information Modeling (BIM) software into a second year Bachelor of Design course. This software has the potential to change industry standards through its ability to revolutionise the work practices of those involved in large scale design projects. Students’ understandings and experiences of using the software in order to complete design projects as part of their assessment are reported here. In depth semi-structured interviews with 6 students revealed that students had views that ranged from novice to sophisticate about the software. They had variations in understanding of how the software could be used to complete course requirements, to assist with the design process and in the workplace. They had engaged in limited exploration of the collaborative potential of the software as a design tool. Their understanding of the significance of BIM for the workplace was also variable. The results indicate that students are beginning to develop an appreciation for how BIM could aid or constrain the work of designers, but that this appreciation is highly varied and likely to be dependent on the students’ previous experiences of working in a design studio environment. Their range of understandings of the significance of the technology is a reflection of their level of development as designers (they are “novice” designers). The results also indicate that there is a need for subjects in later years of the course that allow students to specialise in the area of digital design and to develop more sophisticated views of the role of technology in the design process. There is also a need to capitalise on the collaborative potential inherent in the software in order to realise its capability to streamline some aspects of the design process. As students become more sophisticated designers we should explore their understanding of the role of technology as a design tool in more depth in order to make recommendations for improvements to teaching and learning practice related to BIM and other digital design tools.

Milk : students building mobile learning games in everyday places

This paper explores how mobile games can transform everyday places into dynamic learning spaces filled with information and inspiration. It discusses the motivation inherent in playing games and creating games for others, and how this stimulates an iterative process of creation and reflection and evokes a natural desire to engage in learning. The use of MiLK at the Adelaide Botanic Gardens is offered as a case in point. MiLK is an authoring tool that allows students and teachers to create and share SMS games for mobile phones. A group of South Australian high school students used MiLK to play a game, create their own games and play each other’s games during a day at the gardens. This paper details the learning processes involved in these activities and how the students reflected on their learning, conducted peer assessment, and engaged in a two-way discussion with their teacher about new technologies and their implications for learning. The paper concludes with a discussion of the needs and requirements of 21st Century learners and how MiLK can support constructivist and connectivist teaching methods that engage learners and may produce an appropriately skilled future workforce.

Planning and evaluation

Introduction: The core business of public health is to protect and promote health in the population. Public health planning is the means to maximise these aspirations. Health professionals develop plans to address contemporary health priorities as the evidence about changing patterns of mortality and morbidity is presented. Officials are also alert to international trends in patterns of disease that have the potential to affect the health of Australians. Integrated planning and preparation is currently underway involving all emergency health services, hospitals and population health units to ensure Australia's quick and efficient response to any major infectious disease outbreak, such as avian influenza (bird flu). Public health planning for the preparations for the Sydney Olympics and Paralympic Games in 2000 took almost three years. ‘Its major components included increased surveillance of communicable disease; presentations to sentinel emergency departments; medical encounters at Olympic venues; cruise ship surveillance; environmental and food safety inspections; bioterrorism surveillance and global epidemic intelligence’ (Jorm et al 2003, 102). In other words, the public health plan was developed to ensure food safety, hospital capacity, safe crowd control, protection against infectious diseases, and an integrated emergency and disaster plan. We have national and state plans for vaccinating children against infectious diseases in childhood; plans to promote dental health for children in schools; and screening programs for cervical, breast and prostate cancer. An effective public health response to a change in the distribution of morbidity and mortality requires planning. All levels of government plan for the public’s health. Local governments (councils) ensure healthy local environments to protect the public’s health. They plan parks for recreation, construct traffic-calming devices near schools to prevent childhood accidents, build shade structures and walking paths, and even embed drafts/chess squares in tables for people to sit and play. Environmental Health officers ensure food safety in restaurants and measure water quality. These public health measures attempt to promote the quality of life of residents. Australian and state governments produce plans that protect and promote health through various policy and program initiatives and innovations. To be effective, program plans need to be evaluated. However, building an integrated evaluation plan into a program plan is often forgotten, as planning and evaluation are seen as two distinct entities. Consequently, it is virtually impossible to measure, with any confidence, the extent to which a program has achieved its goals and objectives. This chapter introduces you to the concepts of public health program planning and evaluation. Case studies and reflection questions are presented to illustrate key points. As various authors use different terminology to describe the same concepts/actions of planning and evaluation, the glossary at the back of this book will help you to clarify the terms used in this chapter.

Caregivers' beliefs about practice in infant child care programmes

Infant caregivers in centre-based child care were videotaped as they interacted with the children during routine and non-routine activities. During a subsequent interview, the video provided a stimulus for discussion and reflection on practices. Caregivers were also asked to write about their beliefs on good practice in caring for infants. Transcripts of the interviews and the written statements were then analysed for evidence of nave and informed beliefs about caregiving. Most caregivers held nave beliefs and only one caregiver had an informed understanding of professional practice with infants. The usefulness of the analytical framework used in this research is discussed as a means for understanding caregiving practices. It has important implications for approaches to initial professional education of early childhood teachers and for professional development programmes.

Use of micro-ATR/FTIR imaging to study heterogeneous polymer oxidation by direct solvent casting onto the ATR IRE

A technique is described whereby micro-ATR/FTIR imaging can be used to follow polymer degradation reactions in situ in real time. The internal reflection element (IRE) assembly is removed from the ATR objective and polymer is solvent cast directly onto the IRE surface. The polymer is then subjected to degradation conditions and molecular structural changes monitored by periodically replacing the IRE assembly back in the ATR objective and collecting spectra which can be used to construct images. This approach has the benefit that the same part of the sample is always studied, and that contact by pressure which might damage the polymer surface is not required. The technique is demonstrated using the polymer Topas which was degraded by exposure to UVC light in air.

Infrared spectroscopic investigation of the effects of titania photocatalyst on the degradation of linear low density polyethylene film for commercial applications

There is a need in industry for a commodity polyethylene film with controllable degradation properties that will degrade in an environmentally neutral way, for applications such as shopping bags and packaging film. Additives such as starch have been shown to accelerate the degradation of plastic films, however control of degradation is required so that the film will retain its mechanical properties during storage and use, and then degrade when no longer required. By the addition of a photocatalyst it is hoped that polymer film will breakdown with exposure to sunlight. Furthermore, it is desired that the polymer film will degrade in the dark, after a short initial exposure to sunlight. Research has been undertaken into the photo- and thermo-oxidative degradation processes of 25 ìm thick LLDPE (linear low density polyethylene) film containing titania from different manufacturers. Films were aged in a suntest or in an oven at 50 °C, and the oxidation product formation was followed using IR spectroscopy. Degussa P25, Kronos 1002, and various organic-modified and doped titanias of the types Satchleben Hombitan and Hunstsman Tioxide incorporated into LLDPE films were assessed for photoactivity. Degussa P25 was found to be the most photoactive with UVA and UVC exposure. Surface modification of titania was found to reduce photoactivity. Crystal phase is thought to be among the most important factors when assessing the photoactivity of titania as a photocatalyst for degradation. Pre-irradiation with UVA or UVC for 24 hours of the film containing 3% Degussa P25 titania prior to aging in an oven resulted in embrittlement in ca. 200 days. The multivariate data analysis technique PCA (principal component analysis) was used as an exploratory tool to investigate the IR spectral data. Oxidation products formed in similar relative concentrations across all samples, confirming that titania was catalysing the oxidation of the LLDPE film without changing the oxidation pathway. PCA was also employed to compare rates of degradation in different films. PCA enabled the discovery of water vapour trapped inside cavities formed by oxidation by titania particles. Imaging ATR/FTIR spectroscopy with high lateral resolution was used in a novel experiment to examine the heterogeneous nature of oxidation of a model polymer compound caused by the presence of titania particles. A model polymer containing Degussa P25 titania was solvent cast onto the internal reflection element of the imaging ATR/FTIR and the oxidation under UVC was examined over time. Sensitisation of 5 ìm domains by titania resulted in areas of relatively high oxidation product concentration. The suitability of transmission IR with a synchrotron light source to the study of polymer film oxidation was assessed as the Australian Synchrotron in Melbourne, Australia. Challenges such as interference fringes and poor signal-to-noise ratio need to be addressed before this can become a routine technique.

A psychometric comparison of the Toronto Alexithymia Scale (TAS-20) and the Observer Alexithymia Scale (OAS) in an alcohol-dependent sample

Alexithymia is characterised by deficits in emotional insight and self reflection, that impact on the efficacy of psychological treatments. Given the high prevalence of alexithymia in Alcohol Use Disorders, valid assessment tools are critical. The majority of research on the relationship between alexithymia and alcohol-dependence has employed the self-administered Toronto Alexithymia Scale (TAS-20). The Observer Alexithymia Scale (OAS) has also been recommended. The aim of the present study was to assess the validity and reliability of the OAS and the TAS-20 in an alcohol-dependent sample. Two hundred and ten alcohol-dependent participants in an outpatient Cognitive Behavioral Treatment program were administered the TAS-20 at assessment and upon treatment completion at 12 weeks. Clinical psychologists provided observer assessment data for a subsample of 159 patients. The findings confirmed acceptable internal consistency, test-retest reliability and scale homogeneity for both the OAS and TAS-20, except for the low internal consistency of the TAS-20 EOT scale. The TAS-20 was more strongly associated with alcohol problems than the OAS.

Beyond September 11 : an anthology of dissent

This tome really is what it says it is: An anthology of dissent. For many of us frustrated at the lack of critical analysis, annoyed by the repetitive, albeit spectacular, images of the falling world trade towers and sickened by the absence of any reflection whatsoever upon ‘America’s Jihad’, this book provides some intellectual solace at long last. It contains 35 short pieces composed by an impressive list of prominent lawyers, academics, human rights activists and journalists. Six of the pieces are re-publications of articles that appeared in the print media commentary soon after 11 September, the other 29 are solicited pieces on a range of topics and angles.

The social role of design on collaborative destination branding : creating a new journey, a new story for the Waterfall Way, New South Wales, Australia.

This paper suggests that collaborative design can be an effective tool to promote social change. A co-design methodology and the results of its application in branding the Waterfall Way (New South Wales, Australia) as an eco- and nature-based tourism destination are presented as an example. The co-design exercise actively involved stakeholders in all stages of the design process, harnessing local tacit knowledge in relation to communication design, stimulating reflection upon what is special about the places, and consequently reinforcing a sense of belonging and the environmental and cultural conservation of place. The achieved results reflect the involvement and ownership of the community towards the design process. However, the application of a collaborative brand design methodology produced more than just a destination brand that is attractive to visitors, in line with local values, ways of living and the environment. It helped to catalyse a social network around tourism, triggering self-organising activity amongst stakeholders, who started to liaise with each other around the emergent regional identity - represented by the new brand they created together. The Waterfall Way branding process is a good example of social construction of shared understanding in and through design, showing that design exercises can have a significant social impact not only on the final product, but also on the realities of people involved in the process.

Cultivating teachers’ beliefs, knowledge and skills for leading change in schools

Australian policy initiatives and state curriculum reform efforts affirm a commitment to address student disengagement through the development of inclusive school environments, curriculum, and pedagogy. This paper, drawing on critical social theory, describes three Australian projects that support the cultivation of teachers’ beliefs, knowledge and skills for critical reflection and leading change in schools. The first project reports on the valued ethics that emerged in pre-service teacher reflections about a Service-learning Program at a university in Queensland. The second project reports on a school-based collaborative inquiry approach to professional development with a focus on literacy practices. The final project reports on an initiative in another university in Victoria, to operationalise pedagogical change and curriculum renewal in Victoria, through the Principles of Learning and Teaching (PoLT). These case studies illustrate how critical reflection and development of beliefs, knowledge and skills can be acquired to better meet the needs of schools.