The provision of patient personal hygiene in the intensive care unit : a descriptive exploratory study of bed-bathing practice

Background/objectives The provision of the patient bed-bath is a fundamental nursing care activity yet few quantitative data and no qualitative data are available on registered nurses’ (RNs) clinical practice in this domain in the intensive care unit (ICU). The aim of this study was to describe ICU RNs current practice with respect to the timing, frequency and duration of the patient bed-bath and the cleansing and emollient agents used. Methods The study utilised a two-phase sequential explanatory mixed method design. Phase one used a questionnaire to survey RNs and phase two employed semi-structured focus group (FG) interviews with RNs. Data was collected over 28 days across four Australian metropolitan ICUs. Ethical approval was granted from the relevant hospital and university human research ethics committees. RNs were asked to complete a questionnaire following each episode of care (i.e. bed-bath) and then to attend one of three FG interviews: RNs with less than 2 years ICU experience; RNs with 2–5 years ICU experience; and RNs with greater than 5 years ICU experience. Results During the 28-day study period the four ICUs had 77.25 beds open. In phase one a total of 539 questionnaires were returned, representing 30.5% of episodes of patient bed-baths (based on 1767 bed occupancy and one bed-bath per patient per day). In 349 bed-bath episodes 54.7% patients were mechanically ventilated. The bed-bath was given between 02.00 and 06.00 h in 161 episodes (30%), took 15–30 min to complete (n = 195, 36.2%) and was completed within the last 8 h in 304 episodes (56.8%). Cleansing agents used were predominantly pH balanced soap or liquid soap and water (n = 379, 71%) in comparison to chlorhexidine impregnated sponges/cloths (n = 86, 16.1%) or other agents such as pre-packaged washcloths (n = 65, 12.2%). In 347 episodes (64.4%) emollients were not applied after the bed-bath. In phase two 12 FGs were conducted (three FGs at each ICU) with a total of 42 RN participants. Thematic analysis of FG transcripts across the three levels of RN ICU experience highlighted a transition of patient hygiene practice philosophy from shades of grey – falling in line for inexperienced clinicians to experienced clinicians concrete beliefs about patient bed-bath needs. Conclusions This study identified variation in process and products used in patient hygiene practices in four ICUs. Further study to improve patient outcomes is required to determine the appropriate timing of patient hygiene activities and cleansing agents used to improve skin integrity.

Sustainable urban development : formulation of indicator-based residential sustainability assessment framework for local level

Purpose–The purpose of this paper is to formulate a conceptual framework for urban sustainability indicators selection. This framework will be used to develop an indicator-based evaluation method for assessing the sustainability levels of residential neighbourhood developments in Malaysia. Design/methodology/approach–We provide a brief overview of existing evaluation frameworks for sustainable development assessment. We then develop a conceptual Sustainable Residential Neighbourhood Assessment (SNA) framework utilising a four-pillar sustainability framework (environmental, social, economic and institutional) and a combination of domain-based and goal-based general frameworks. This merger offers the advantages of both individual frameworks, while also overcoming some of their weaknesses when used to develop the urban sustainability evaluation method for assessing residential neighbourhoods. Originality/value–This approach puts in evidence that many of the existing frameworks for evaluating urban sustainability do not extend their frameworks to include assessing housing sustainability at a local level. Practical implications–It is expected that the use of the indicator-based Sustainable Neighbourhood Assessment framework will present a potential mechanism for planners and developers to evaluate and monitor the sustainability performance of residential neighbourhood developments.

Improving governance : practical methods and an analytic framework for the enhancement of democracy

Seven endemic governance problems are shown to be currently present in governments around the globe and at any level of government as well (for example municipal, federal). These problems have their roots traced back through more than two thousand years of political, specifically ‘democratic’, history. The evidence shows that accountability, transparency, corruption, representation, campaigning methods, constitutionalism and long-term goals were problematic for the ancient Athenians as well as modern international democratisation efforts encompassing every major global region. Why then, given the extended time period humans have had to deal with these problems, are they still present? At least part of the answer to this question is that philosophers, academics and NGOs as well as MNOs have only approached these endemic problems in a piecemeal manner with a skewed perspective on democracy. Their works have also been subject to the ebbs and flows of human history which essentially started and stopped periods of thinking. In order to approach the investigation of endemic problems in relation to democracy (as the overall quest of this thesis was to generate prescriptive results for the improvement of democratic government), it was necessary to delineate what exactly is being written about when using the term ‘democracy’. It is common knowledge that democracy has no one specific definition or practice, even though scholars and philosophers have been attempting to create a definition for generations. What is currently evident, is that scholars are not approaching democracy in an overly simplified manner (that is, it is government for the people, by the people) but, rather, are seeking the commonalities that democracies share, in other words, those items which are common to all things democratic. Following that specific line of investigation, the major practiced and theoretical versions of democracy were thematically analysed. After that, their themes were collapsed into larger categories, at which point the larger categories were comparatively analysed with the practiced and theoretical versions of democracy. Four democratic ‘particles’ (selecting officials, law, equality and communication) were seen to be present in all practiced and theoretical democratic styles. The democratic particles fused with a unique investigative perspective and in-depth political study created a solid conceptualisation of democracy. As such, it is argued that democracy is an ever-present element of any state government, ‘democratic’ or not, and the particles are the bodies which comprise the democratic element. Frequency- and proximity-based analyses showed that democratic particles are related to endemic problems in international democratisation discourse. The linkages between democratic particles and endemic problems were also evident during the thematic analysis as well historical review. This ultimately led to the viewpoint that if endemic problems are mitigated the act may improve democratic particles which might strengthen the element of democracy in the governing apparatus of any state. Such may actively minimise or wholly displace inefficient forms of government, leading to a government specifically tailored to the population it orders. Once the theoretical and empirical goals were attained, this thesis provided some prescriptive measures which government, civil society, academics, professionals and/or active citizens can use to mitigate endemic problems (in any country and at any level of government) so as to improve the human condition via better democratic government.

Adoption Law and Practice [2nd ed.]

This book addresses the modern law relating to adoption. It comes at a time of fundamental change in adoption practice as, increasingly, Irish couples look outside the jurisdiction for the child that will make their family complete.---------- * Examines and explains the new regulatory framework and the law now governing domestic and intercountry adoption.---------- * Provides a guide to the changes outlined in the Adoption Bill 2008 which also consolidates the provisions of seven previous statutes and incorporates the Hague Convention into Irish statute law.---------- * Considers the responsibilities of the new Adoption Authority, and the roles of other administrative and legal bodies.---------- * Sets out the adoption process, explaining the complexities of intercountry adoption, giving consideration to the interface between adoption and children in care and dealing with the rights of the parties involved.

A conceptual framework for ethical decision making in project procurement

There is a lack of research which identifies the role of the public-sector client in relation to ethical practice in plan procurement. This paper discusses a conceptual framework for ethical decision making in project procurement, focusing on public sector clients within the Malaysian construction industry. A framework is proposed to ensure that effective ethical decision making strategies are deployed to ensure that plan procurement is carried out with a transparent process so that the public sector clients are able to adopt. The conceptual framework adopts various factors that contribute to ethical decision making at the early stage of procurement and consists of the procurement system, individual factors, project characteristics, and organizational culture as the internal factors and professional code of conduct and government policies as the external factors. This framework rationalizes the relationships between systems, psychology and organizational theory to form an innovative understanding of making ethical decisions in plan procurement. It is expected that this proposed framework will be useful as a foundation for identifying the factors that contribute to ethical decision making focusing on the planning stage of procurement process.

Towards a relational contracting framework in the Australian construction industry : an initial framework

The Australian construction industry is characterized as being a competitive and risky business environment due to lack of cooperation, insufficient trust, ineffective communication and adversarial relationships which are likely lead to poor project performance. Relational contracting (RC) is advocated by literature as an innovative approach to improve the procurement process in the construction industry. Various studies have collectively added to the current knowledge of known RC norms, but there seem to be little effort on investigating the determinants of RC and its impact on project outcomes. In such circumstances, there is lack of evidence and explanation on the manner on how these issues lead to different performance. Simultaneously, the New Engineering Contract (NEC) that embraced the concept of RC is seen as a modern way of contracting and also considered as one of the best approaches to the perennial problem of improving adversarial relationships within the industry. The reality of practice of RC in Australia is investigated through the lens of the NEC. A synthesis of literature views on the concept, processes and tools of RC is first conducted to develop the framework of RC. A case study approach is proposed for an in-depth analysis to explore the critical issues addressed by RC in relation to project performance. Understanding the realities of RC will assist stakeholders in the construction industry with their investment in RC.

Review of regulatory framework for environmental information

If Australian scientists are to fully and actively participate in international scientific collaborations utilising online technologies, policies and laws must support the data access and reuse objectives of these projects. To date Australia lacks a comprehensive policy and regulatory framework for environmental information and data generally. Instead there exists a series of unconnected Acts that adopt historically-based, sector-specific approaches to the collection, use and reuse of environmental information. This paper sets out the findings of an analysis of a representative sample of Australian statutes relating to environmental management and protection to determine the extent to which they meet best practice criteria for access to and reuse of environmental information established in international initiatives. It identifies issues that need to be addressed in the legislation governing environmental information to ensure that Australian scientists are able to fully engage in international research collaborations.

A framework for reasoning about inherent parallelism in modern object-oriented languages

With the emergence of multi-core processors into the mainstream, parallel programming is no longer the specialized domain it once was. There is a growing need for systems to allow programmers to more easily reason about data dependencies and inherent parallelism in general purpose programs. Many of these programs are written in popular imperative programming languages like Java and C]. In this thesis I present a system for reasoning about side-effects of evaluation in an abstract and composable manner that is suitable for use by both programmers and automated tools such as compilers. The goal of developing such a system is to both facilitate the automatic exploitation of the inherent parallelism present in imperative programs and to allow programmers to reason about dependencies which may be limiting the parallelism available for exploitation in their applications. Previous work on languages and type systems for parallel computing has tended to focus on providing the programmer with tools to facilitate the manual parallelization of programs; programmers must decide when and where it is safe to employ parallelism without the assistance of the compiler or other automated tools. None of the existing systems combine abstraction and composition with parallelization and correctness checking to produce a framework which helps both programmers and automated tools to reason about inherent parallelism. In this work I present a system for abstractly reasoning about side-effects and data dependencies in modern, imperative, object-oriented languages using a type and effect system based on ideas from Ownership Types. I have developed sufficient conditions for the safe, automated detection and exploitation of a number task, data and loop parallelism patterns in terms of ownership relationships. To validate my work, I have applied my ideas to the C] version 3.0 language to produce a language extension called Zal. I have implemented a compiler for the Zal language as an extension of the GPC] research compiler as a proof of concept of my system. I have used it to parallelize a number of real-world applications to demonstrate the feasibility of my proposed approach. In addition to this empirical validation, I present an argument for the correctness of the type system and language semantics I have proposed as well as sketches of proofs for the correctness of the sufficient conditions for parallelization proposed.

Wellness in higher education : a transformative framework for health related disciplines

The perceived benefits of Wellness Education in University environments are substantiated by a number of studies in relation to the place, impact and purpose of Wellness curricula. Many authors recommend that Wellness curriculum design must include personal experiences, reflective practice and active self-managed learning approaches in order to legitimise the adoption of Wellness as a personal lifestyle approach. Wellness Education provides opportunities to engage in learning self-regulation skills both within and beyond the context of the Wellness construct. Learner success is optimised by creating authentic opportunities to develop and practice self regulation strategies that facilitate making meaning of life's experiences. Such opportunities include provision of options for self determined outcomes and are scaffolded according to learner needs; thus, configuring a learner-centred curriculum in Wellness Education would potentially benefit by overlaying principles from the domains of Self Determination Theory, Self Regulated Learning and Transformative Education Theory to highlight authentic, transformative learning as a lifelong approach to Wellness.

Australian ePortfolio Project–Stage 2 ePortfolio use by university students in Australia : Developing a sustainable community of practice Case studies extracted from the final project report December 2009

Fourteen sase studies extracted from the final project report - December 2009 Australian Flexible Learning Framework: E-portfolios Community of Practice (Aus) Personal learning plans and ePortfolio (Aus) RMIT University: Introducing ePortfolios (Aus) ePortfolio Practice: ALTC Exchange (Aus) Australian PebblePad User Group (APpUG) (Aus) ePortfolios in the library and information services sector (Aus) PDP and ePortfolios UK (UK) SURF NL Portfolio (Netherlands) University of Canterbury ePortfolio (NZ) AAEEBL: Association for Authentic, Experiential and Evidence-Based Learning (USA) Midlands Eportfolio Group, West Midlands(UK) EPAC: Electronic Portfolio Action and Communication (USA) Scottish Higher Education PDP Forum (UK) Centre for Recording Achievement (CRA)(UK)

Inclusive universal design practice and activism : a case study

This paper reports on a unique approach to inclusive practice that responds to several critical issues highlighted in the first Universal Design (UD) Conference in Yokohama as well as in more recent literature on universal design. The approach, as explained in the paper, involves a not-for-profit community organization, university researchers, and a design action group comprising practitioners from across the design disciplines, together with other specialist consultants, developing a voluntary capacity an independent housing model for people with disabilities and their families or caretakers. With a focus on relationships and "a system that places human beings at the centre in all respects", this paper presents the approach and the ermerging theoretical framework which addresses three issues that afacan and Erbug (2009) propose hinder the integration of universal design with design practice, namely: theory-practice inconsistency involving the lack of flow-on of universal design awareness into design practice; a way of thinking that exhibits very little empathy with and understanding of the requirements of diverse users; and poorly implemented and coordinated collaboration and communication involving designers and other professionals (pp. 731 - 732).

Strategic management of technology in construction : a framework and case study

This case study analyzes a firm's technology strategy for its fit or match with the requirements of the industry environment in which it operates. Understanding the relationships between market characteristics and technology strategies can assist managers in making complex and difficult decisions regarding their use of technology to improve competitive performance. Using the technology strategy framework, managers can map their own capabilities for comparison with the more appropriate or superior approach to technology in that industry environment. Alternatively, firms seeking to transition from one industry niche or environment to another could identify and move to acquire the required capabilities. The dynamics of industry competition, both domestic and international, emphasize the need for improved management of the strategic fit between technical capabilities and industry environment.

Re-engineering project planning processes : a best practice model for managing project phase integration issues

Competitive markets are increasingly driving new initiatives for shorter cycle times resulting in increased overlapping of project phases. This, in turn, necessitates improving the interfaces between the different phases to be overlapped (integrated), thus allowing transfer of processes, information and knowledge from one individual or team to another. This transfer between phases, within and between projects, is one of the basic challenges to the philosophy of project management. To make the process transfer more transparent with minimal loss of momentum and project knowledge, this paper draws upon Total Quality Management (TQM) and Business Process Re-engineering (BPR) philosophies to develop a Best Practice Model for managing project phase integration. The paper presents the rationale behind the model development and outlines its two key parts; (1) Strategic Framework and (2) Implementation Plan. Key components of both the Strategic Framework and the Implementation Plan are presented and discussed.

Loculus : an ontology-based information management framework for the motion picture industry

"How do you film a punch?" This question can be posed by actors, make-up artists, directors and cameramen. Though they can all ask the same question, they are not all seeking the same answer. Within a given domain, based on the roles they play, agents of the domain have different perspectives and they want the answers to their question from their perspective. In this example, an actor wants to know how to act when filming a scene involving a punch. A make-up artist is interested in how to do the make-up of the actor to show bruises that may result from the punch. Likewise, a director wants to know how to direct such a scene and a cameraman is seeking guidance on how best to film such a scene. This role-based difference in perspective is the underpinning of the Loculus framework for information management for the Motion Picture Industry. The Loculus framework exploits the perspective of agent for information extraction and classification within a given domain. The framework uses the positioning of the agent’s role within the domain ontology and its relatedness to other concepts in the ontology to determine the perspective of the agent. Domain ontology had to be developed for the motion picture industry as the domain lacked one. A rule-based relatedness score was developed to calculate the relative relatedness of concepts with the ontology, which were then used in the Loculus system for information exploitation and classification. The evaluation undertaken to date have yielded promising results and have indicated that exploiting perspective can lead to novel methods of information extraction and classifications.

Towards a model for the analysis and description of mathematical knowledge and understanding

Mathematics education literature has called for an abandonment of ontological and epistemological ideologies that have often divided theory-based practice. Instead, a consilience of theories has been sought which would leverage the strengths of each learning theory and so positively impact upon contemporary educational practice. This research activity is based upon Popper’s notion of three knowledge worlds which differentiates the knowledge shared in a community from the personal knowledge of the individual, and Bereiter’s characterisation of understanding as the individual’s relationship to tool-like knowledge. Using these notions, a re-conceptualisation of knowledge and understanding and a subsequent re-consideration of learning theories are proposed as a way to address the challenge set by literature. Referred to as the alternative theoretical framework, the proposed theory accounts for the scaffolded transformation of each individual’s unique understanding, whilst acknowledging the existence of a body of domain knowledge shared amongst participants in a scientific community of practice. The alternative theoretical framework is embodied within an operational model that is accompanied by a visual nomenclature with which to describe consensually developed shared knowledge and personal understanding. This research activity has sought to iteratively evaluate this proposed theory through the practical application of the operational model and visual nomenclature to the domain of early-number counting, addition and subtraction. This domain of mathematical knowledge has been comprehensively analysed and described. Through this process, the viability of the proposed theory as a tool with which to discuss and thus improve the knowledge and understanding with the domain of mathematics has been validated. Putting of the proposed theory into practice has lead to the theory’s refinement and the subsequent achievement of a solid theoretical base for the future development of educational tools to support teaching and learning practice, including computer-mediated learning environments. Such future activity, using the proposed theory, will advance contemporary mathematics educational practice by bringing together the strengths of cognitivist, constructivist and post-constructivist learning theories.