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.

Towards making a difference through a university-TAFE partnership : mentoring potential teacher aides

Universities promote partnerships as an investment of social capital that may benefit communities. Mentoring of university students in schools has become key to induction of education workplace practices. One such arrangement is the mentoring of students from TAFE who endeavour to become teacher aides. However, there is no theoretical model for mentoring teacher aides and, similar to mentoring preservice teachers, such practices vary in quality and quantity. What are mentors’ perceptions of mentoring potential teacher aides within school settings? This mixed-method research involves a survey with extended responses. The aim is to determine practices and strategies for mentoring potential teacher aides (PTAs). Results indicated that PTAs require induction about the school culture and infrastructure, which includes ethics, values, operational plans, awareness of facilities and a range of other inductions that would aid the PTA’s work practices. Findings also revealed that many of the mentoring practices employed for preservice teachers may be used for mentoring PTAs in school settings. Indeed, mentors require personal attributes to facilitate the mentoring process. They also indicated outlining the education system requirements as fundamental to workplace operations. In addition, as most PTAs work with students in the classroom, the mentor’s pedagogical knowledge can further assist PTAs to develop an understanding of effective pedagogical practices, particularly for small groups or one-on-one sessions. Finally, a mentor’s modelling of practices and providing constructive feedback about the PTA’s practices can assist the development of workplace operations. In conclusion, the survey employed in this study may assist organisations to develop protocols of practice for workplace mentors. PTAs require mentors who are versed in effective mentoring practices that can more readily guide them towards success.

The role of bricolage and resource constraints in high potential sustainability ventures

Sustainability decisions and their impacts may be among the greatest challenges facing the world in the 21st century (Davos 2000). Apart from adaptation on the part of established organizations these challenges are arguably going to require solutions developed by new actors However, young ventures have only recently begun generating research interest within sustainability literature (Shepherd et al. 2009). In particular, little is known about resource behaviours of these ventures and how they adapt to substantial resource constraints. One promising theory that has been identified as a way that some entrepreneurs manage constraints is bricolage: a construct defined as “making do by applying combinations of the resources at hand to new problems and opportunities” (Baker and Nelson 2005: 333). Bricolage may be critical as the means of continued venture success as these ventures are frequently developed in severe resource constraint, owing to higher levels of technical sophistication (Rothaermel and Deeds 2006). Further, they are often developed by entrepreneurs committed to personal and social goals of resourcefulness, including values that focus on conservation rather than consumption of resources (Shepherd et al. 2009). In this paper, using seven novel cases of high potential sustainability firms from CAUSEE we consider how constraints impact resource behaviours and further illustrate and extend bricolage domains previously developed by Baker and Nelson (2005) with recommendations for theory and practice provided.

Do Chinese traditional values matter in regulating China’s company directors? Preliminary findings from surveys in Hong Kong

This article argues that Chinese traditional values do matter in Chinese corporate governance. The object is to report on the preliminary findings of a project supported by the General Research Fund in Hong Kong (HK). Thus far the survey results from HK respondents support the authors’ hypothesis. As such, traditional Chinese values should be on the agenda of the next round of company law reforms in China

Where money and meanings meet : theorizing the emergence of new values in media and education

Recent developments in technology, globalization, and consumer activism have challenged the "broadcasting model" of natonally bounded, vertically integrated, monopolistic, expert-paradigm media industries, dedicated to supplying leisure entertainment to more or less passive consumers. Instead, attention has turned to globally traded formats, social network markets, consumer-created content, multiplatform "publication," and a semiotic long tail where niche representations can be as valuable as blockbusters. Such chenges are just as much a challenge to education as they are to business models. And education, both formal and informal, is a dynamic agent in these processes, participation, and creative content require a rethink of "studies" just as much as of "media."

Connected Communities and Creative Economy; Clash, cluster, complexity, creativity

After a brief personal orientation, this presentation offers an opening section on „clash, cluster, complexity, cities‟ – making the case that innovation (both creative and economic) proceeds not only from incremental improvements within an expert-pipeline process, but also from the clash of different systems, generations, and cultures. The argument is that cultural complexity arises from such clashes, and that clustering is the solution to problems of complexity. The classic, 10,000-year-old, institutional form taken by such clusters is … cities. Hence, a creative city is one where clashing and competitive complexity is clustered… and, latterly, networked.

Informational city

Many cities worldwide face the prospect of major transformation as the world moves towards a global information order. In this new era, urban economies are being radically altered by dynamic processes of economic and spatial restructuring. The result is the creation of ‘informational cities’ or its new and more popular name, ‘knowledge cities’. For the last two centuries, social production had been primarily understood and shaped by neo-classical economic thought that recognized only three factors of production: land, labor and capital. Knowledge, education, and intellectual capacity were secondary, if not incidental, factors. Human capital was assumed to be either embedded in labor or just one of numerous categories of capital. In the last decades, it has become apparent that knowledge is sufficiently important to deserve recognition as a fourth factor of production. Knowledge and information and the social and technological settings for their production and communication are now seen as keys to development and economic prosperity. The rise of knowledge-based opportunity has, in many cases, been accompanied by a concomitant decline in traditional industrial activity. The replacement of physical commodity production by more abstract forms of production (e.g. information, ideas, and knowledge) has, however paradoxically, reinforced the importance of central places and led to the formation of knowledge cities. Knowledge is produced, marketed and exchanged mainly in cities. Therefore, knowledge cities aim to assist decision-makers in making their cities compatible with the knowledge economy and thus able to compete with other cities. Knowledge cities enable their citizens to foster knowledge creation, knowledge exchange and innovation. They also encourage the continuous creation, sharing, evaluation, renewal and update of knowledge. To compete nationally and internationally, cities need knowledge infrastructures (e.g. universities, research and development institutes); a concentration of well-educated people; technological, mainly electronic, infrastructure; and connections to the global economy (e.g. international companies and finance institutions for trade and investment). Moreover, they must possess the people and things necessary for the production of knowledge and, as importantly, function as breeding grounds for talent and innovation. The economy of a knowledge city creates high value-added products using research, technology, and brainpower. Private and the public sectors value knowledge, spend money on its discovery and dissemination and, ultimately, harness it to create goods and services. Although many cities call themselves knowledge cities, currently, only a few cities around the world (e.g., Barcelona, Delft, Dublin, Montreal, Munich, and Stockholm) have earned that label. Many other cities aspire to the status of knowledge city through urban development programs that target knowledge-based urban development. Examples include Copenhagen, Dubai, Manchester, Melbourne, Monterrey, Singapore, and Shanghai. Knowledge-Based Urban Development To date, the development of most knowledge cities has proceeded organically as a dependent and derivative effect of global market forces. Urban and regional planning has responded slowly, and sometimes not at all, to the challenges and the opportunities of the knowledge city. That is changing, however. Knowledge-based urban development potentially brings both economic prosperity and a sustainable socio-spatial order. Its goal is to produce and circulate abstract work. The globalization of the world in the last decades of the twentieth century was a dialectical process. On one hand, as the tyranny of distance was eroded, economic networks of production and consumption were constituted at a global scale. At the same time, spatial proximity remained as important as ever, if not more so, for knowledge-based urban development. Mediated by information and communication technology, personal contact, and the medium of tacit knowledge, organizational and institutional interactions are still closely associated with spatial proximity. The clustering of knowledge production is essential for fostering innovation and wealth creation. The social benefits of knowledge-based urban development extend beyond aggregate economic growth. On the one hand is the possibility of a particularly resilient form of urban development secured in a network of connections anchored at local, national, and global coordinates. On the other hand, quality of place and life, defined by the level of public service (e.g. health and education) and by the conservation and development of the cultural, aesthetic and ecological values give cities their character and attract or repel the creative class of knowledge workers, is a prerequisite for successful knowledge-based urban development. The goal is a secure economy in a human setting: in short, smart growth or sustainable urban development.

Making sense of brain tumour: A qualitative investigation of personal and social processes of adjustment

This study investigated personal and social processes of adjustment at different stages of illness for individuals with brain tumour. A purposive sample of 18 participants with mixed tumour types (9 benign and 9 malignant) and 15 family caregivers was recruited from a neurosurgical practice and a brain tumour support service. In-depth semi-structured interviews focused on participants’ perceptions of their adjustment, including personal appraisals, coping and social support since their brain tumour diagnosis. Interview transcripts were analysed thematically using open, axial and selective coding techniques. The primary theme that emerged from the analysis entailed “key sense making appraisals”, which was closely related to the following secondary themes: (1) Interactions with those in the healthcare system, (2) reactions and support from the personal support network, and (3) a diversity of coping efforts. Adjustment to brain tumour involved a series of appraisals about the illness that were influenced by interactions with those in the healthcare system, reactions and support from people in their support network, and personal coping efforts. Overall, the findings indicate that adjustment to brain tumour is highly individualistic; however, some common personal and social processes are evident in how people make sense of and adapt to the illness over time. A preliminary framework of adjustment based on the present findings and its clinical relevance are discussed. In particular, it is important for health professionals to seek to understand and support individuals’ sense-making processes following diagnosis of brain tumour.

The Culture of Older Women’s Drinking in Australia

The purpose of this investigation was to undertake pilot research to develop an understanding of the current culture of older Australian women’s (35-50 years) drinking behaviour from a uniquely female perspective. Methods Two separate focus group interviews were undertaken with women (N = 11) aged between 35 and 50 years living in South-East Queensland, Australia. Women were asked to openly discuss how and why they drink alcohol (ie., their regular drinking behaviour), how this has changed over time, and the attitudes and values that influence their behaviour. Results Participants reported that their consumption of alcohol was more regulated and controlled and although some women drank more frequently, the quantity consumed at each drinking occasion had decreased significantly. Occasional consumption of large amounts of alcohol tended to be the result of ‘incidental drinking’ as opposed to ‘determined drinking’. The reasons for alcohol consumption were found to be internal as well as social. Internal reasons included stress relief, increased relaxation and self reward. Further, alcohol was used as a social lubricant. This cohort also reported being influenced by the drinking patterns of their partners. Social group matching was however found to have a negative impact on alcohol consumption as social groups most commonly endorsed lesser levels of intoxication. Further, the women reported that they were of an age in which they felt excessive drinking to be ‘undignified’. Personal reasons such as vocational and family responsibilities further modified the levels of consumption for individual women. Finally, it was reported that perceived health risks that can result from excessive and/or repetitive drinking led to a decreased in consumption. Conclusion It is proposed that the findings of this investigation could be used to improve current knowledge regarding more mature women’s drinking culture, associated risks and risk prevention strategies.

If Big Brother comes to a venue near you! Employee surveillance issues and the communication professional

Todoy's monogers-drowing on the expertise of their IT professiono/s-personal reasons. Top Fortune 500 US companies have reported losing billions of dollars because of 'cyber-Ioofing'. Yet workploce surveiffonce-token to extremesmay impact negatively on perceived levels of trust within the organisation, cantribute to employees' increased stress and decreased job dissatisfaction, and affect productivity. Highlighted are current trends in workplace privacy, key communication and control issues, the current legal climate, and ethical issues that communication professionals need to address to forestall future problems. lA questionnaire is included as a starting point for communication professionals to assess their own attitudes and values to workplace surveillance.

Values-driven leadership

The values of a leader set the culture of an organisation, determine the effectiveness of an organisation, and determine the success of an organisation. Understanding our values and being able to live our values adds significant emphasis to the leadership roles we perform in life. This book looks at where our values come from, and their role and impact in an organisational context. It offers a detailed conversation about values driven leadership - what it is and what it looks like.

Discriminative optimisation of the figure of merit for phonetic spoken term detection

This work proposes to improve spoken term detection (STD) accuracy by optimising the Figure of Merit (FOM). In this article, the index takes the form of phonetic posterior-feature matrix. Accuracy is improved by formulating STD as a discriminative training problem and directly optimising the FOM, through its use as an objective function to train a transformation of the index. The outcome of indexing is then a matrix of enhanced posterior-features that are directly tailored for the STD task. The technique is shown to improve the FOM by up to 13% on held-out data. Additional analysis explores the effect of the technique on phone recognition accuracy, examines the actual values of the learned transform, and demonstrates that using an extended training data set results in further improvement in the FOM.

Assessing the impact of transit and personal characteristics on mode choice of TOD users

Comparison are required to understand transport benefits of Transit Oriented Developments (TODs). Mode shares of TOD users need to be understood. Accurate travel demand models for TODs are needed.

Expected values for pedometer-determined physical activity in youth

This review assembles pedometry literature focused on youth, with particular attention to expected values for habitual, school day, physical education class, recess, lunch break, out-of-school, weekend, and vacation activity. From 31 studies published since 1999, we constructed a youth habitual activity step-curve that indicates: (a) from ages 6 to 18 years, boys typically take more steps per day than girls; (b) for both sexes the youngest age groups appear to take fewer steps per day than those immediately older; and (c) from a young age, boys decline more in steps per day to become move consistent with girls at older ages. Additional studies revealed that boys take approximately 42-49% of daily steps during the school day; girls take 41-47%. Steps taken during physical education class contribute to total steps per day by 8.7-23.7% in boys and 11.4-17.2% in girls. Recess represents 8-11% and lunch break represents 15-16% of total steps per day. After-school activity contributes approximately 47-56% of total steps per day for boys and 47-59% for girls. Weekdays range from approximately 12,000 to 16,000 steps per day in boys and 10,000 to 14,000 steps per day in girls. The corresponding values for weekend days are 12,000-13,000 steps per day in boys and 10,000-12,000 steps per day in girls.

Response to "a step in the right direction : commentary on expected values for pedometer-determined physical activity in youth"

The figure Beets took exception to displays sex‐ and age‐specific median values of aggregated published expected values for pedometer determined physical activity.