Evaluation of contextual influences on the medication administration practice of paediatric nurses

Aim. This paper is a report of a study conducted to explore the impact of preidentified contextual themes (related to work environment and socialization) on nursing medication practice. Background. Medication administration is a complex aspect of paediatric nursing and an important component of day-to-day nursing practice. Many attempts are being made to improve patient safety, but many errors remain. Identifying and understanding factors that influence medication administration errors are of utmost importance. Method. A cross-sectional survey was conducted with a sample of 278 paediatric nurses from the emergency department, intensive care unit and medical and surgical wards of an Australian tertiary paediatric hospital in 2004. The response rate was 67%. Result. Contextual influences were important in determining how closely medication policy was followed. Completed questionnaires were returned by 185 nurses (67%). Younger nurses aged <34 years thought that their medication administration practice could be influenced by the person with whom they checked the drugs (P = 0·001), and that there were daily circumstances when it was acceptable not to adhere strictly to medication policy (P < 0·001), including choosing between following policy and acting in the best interests of the child (P = 0·002). Senior nurses agreed that senior staff dictate acceptable levels of medication policy adherence through role modelling (P = 0·01). Less experienced nurses reported greater confidence with computer literacy (P < 0·001). Conclusions. Organizations need to employ multidisciplinary education programmes to promote universal understanding of, and adherence to, medication policies. Skill mix should be closely monitored to ensure adequate support for new and junior staff.

Disrupting the new orthodoxy : emergency intervention and Indigenous social policy

This article develops a critical analysis of the ideological framework that informed the Australian Federal government’s 2007 intervention into Northern Territory Indigenous communities (ostensibly to address the problem of child sexual abuse). Continued by recently elected Prime Minister, Kevin Rudd, the NT ‘emergency response’ has aroused considerable public debate and scholarly inquiry. In addressing what amounts to a broad bi-partisan approach to Indigenous issues we highlight the way in which Indigenous communities are problematised and therefore subject to interventionist regimes that override differentiated Indigenous voices and intensify an internalised sense of rage occasioned by disempowering interventionist projects. We further argue that in rushing through the emergency legislation and suspending parts of the Racial Discrimination Act, the Howard and Rudd governments have in various ways perpetuated racialised and neo-colonial forms of intervention that override the rights of Indigenous people. Such policy approaches require critical understanding on the part of professions involved most directly in community practice, particularly when it comes to mounting effective opposition campaigns. The article offers a contribution to this end.

ePortfolio use by university students in Australia : Developing a sustainable community of practice

This report documents Stage Two of the Australian ePortfolio Project (AeP2), to specifically explore the current scope of national and international ePortfolio communities of practice in order to identify the factors that have contributed to their success and sustainability. The study has built on Stage One of the Australian ePortfolio Project (Hallam, Harper, McCowan, Hauville, McAllister, & Creagh, 2008), which outlined the broad range of issues and challenges, as well as significant opportunities, that faced the higher education sector in terms of ePortfolio practice, to determine how the emergent community of ePortfolio researchers and practitioners in Australia might be advanced. ---------- The overarching aims of this project were to focus on building the Australian community of practice through an online forum and further symposium activities. Through the research activities the project sought to generate the following major outcomes: develop a forum within the ALTC Exchange to support an ePortfolio community of practice; develop strategies to encourage interest in and engagement with community of practice activities; develop and promote resources to support the diverse stakeholders in ePortfolio practice; collaborate in the establishment of a cross-sector ePortfolio community of practice; host a second Australian ePortfolio Symposium (AeP2) to disseminate the findings from the Australian ePortfolio Project, to explore innovative practice in ePortfolio use in higher education, to articulate policy developments, and to stimulate discussion on international ePortfolio issues; host an associated trade display as a forum for strengthening the higher education sector’s understanding of the features and functionality of ePortfolio platforms; develop resources to support an ePortfolio symposium model that may be adopted for future events. ----------- The project activities encompassed a survey of stakeholders, a program of semi-structured interviews with community managers and a series of case studies depicting successful ePortfolio communities. The survey of ePortfolio practitioners sought to determine the potential value of an ePortfolio CoP, the preferred focus for and the desired features of such a community, as well as the options for the technical and social architecture of an online forum. Through the semi-structured interviews it was possible to examine current examples of CoP activity, to identify the critical success factors and the challenges faced by individual ePortfolio CoPs, so that the attributes of good practice could be presented. The data collected in the interviews contributed to the development of 14 case studies, which have been beneficial in illustrating the diverse nature of CoPs in Australia and overseas.----------- The report presents a rich picture of national and international ePortfolio communities of practice, with an examination of the factors that have contributed to their success and sustainability.

Lifting the lifegiving dollar : case samples of creative practice in health and medical research philanthropy

This study aims to stimulate thought, debate and action for change on this question of more vigorous philanthropic funding of Australian health and medical research (HMR). It sharpens the argument with some facts and ideas about HMR funding from overseas sources. It also reports informed opinions from those working, giving and innovating in this area. It pinpoints the range of attitudes to HMR giving, both positive and negative. The study includes some aspects of Government funding as part of the equation, viewing Government as major HMR givers, with particular ability to partner, leverage and create incentives. Stimulating new philanthropy takes active outreach. The opportunity to build more dialogue between the HMR industry and the wider community is timely given the ‘licence to practice’ issues and questioned trust that applies currently somewhat both to science and to the charitable sector. This interest in improving HMR philanthropy also coincides with the launch last year by the Federal Government of Nonprofit Australia Limited (NAL), a group currently assessing infrastructure improvements to the charitable sector. History suggests no one will create this change if Research Australia does not. However, interest in change exists in various quarters. For Research Australia to successfully change the culture of Australian HMR giving, the process will drive the outcomes. Obviously stakeholder buy-in and partners will be needed and the ultimate blueprint for greater philanthropic HMR funding here will not be this document. Instead it will be the one that wears the handprint and ‘mindprint’ of the many architects and implementers interested in promoting HMR philanthropy, from philanthropists to nonprofit peaks to government policy arms. As the African proverb says, ‘If you want to go fast, go alone; but if you want to go far, go with others’.

Best Practice

The overall theme for the 4th Biennial International Network of Indigenous Health Knowledge and Development (INIHKD)Conference was ‘Knowing Our Roots: Indigenous Medicines, Health Knowledges and Best Practices’. Conference activities were grouped around the following broad themes: •Building of Indigenous research capacity, partnerships and workforce; •Sharing of innovative, traditional and contemporary Indigenous knowledges, especially with respect to culturally-grounded interventions and evidenced-based “best and promising practices”; •Identification of successful Indigenous health policy solutions; and •Sharing of ethical, Indigenous-based research protocols and methodologies. This keynote plenary presentation focused on 'best practice' in research asking the questions: What kind of research will I do? What kind of research will I be? What is the contribution that I will make? what will be my legacy?

Evidence-based practice

Introduction This chapter traces the history of evidence-based practice from its roots in evidence-based medicine to contemporary thinking about the usefulness of such an approach to practice. It defines evidence-based practice and differentiates it from terms such as evidence-based medicine, evidence-based policy and evidence-based healthcare. As evidence-based practice is concerned with identifying ‘good evidence’, this chapter will first describe the nature and production of knowledge, as it is important to understand the subjective nature of knowledge and the research process. The chapter considers the necessary skills for evidence-based practice, and discusses the processes of attaining the necessary evidence and its limitations. We examine the barriers and facilitators to identifying and implementing ‘best practice’ and when evidence-based practice is appropriate to use. The chapter concludes with a discussion about the limitations of evidence-based practice and the potential use of other sources of information to guide practice.

The core role of the nurse practitioner: practice, professionalism and clinical leadership.

AIM: To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. BACKGROUND: Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally. METHOD: This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data. FINDINGS: The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care. CONCLUSION: A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide new perspectives to inform the international debate about this extended level of nursing practice. RELEVANCE TO CLINICAL PRACTICE: The findings from this research have the potential to achieve a standardised approach and internationally consistent nomenclature for the nurse practitioner role.

Designing ePortfolios for music postgraduate study : a practice-led inquiry

In this research I have examined how ePortfolios can be designed for Music postgraduate study through a practice led research enquiry. This process involved designing two Web 2.0 ePortfolio systems for a group of five post graduate music research students. The design process revolved around the application of an iterative methodology called Software Develop as Research (SoDaR) that seeks to simultaneously develop design and pedagogy. The approach to designing these ePortfolio systems applied four theoretical protocols to examine the use of digitised artefacts in ePortfolio systems to enable a dynamic and inclusive dialogue around representations of the students work. The research and design process involved an analysis of existing software and literature with a focus upon identifying the affordances of available Web 2.0 software and the applications of these ideas within 21st Century life. The five post graduate music students each posed different needs in relation to the management of digitised artefacts and the communication of their work amongst peers, supervisors and public display. An ePortfolio was developed for each of them that was flexible enough to address their needs within the university setting. However in this first SoDaR iteration data gathering phase I identified aspects of the university context that presented a negative case that impacted upon the design and usage of the ePortfolios and prevented uptake. Whilst the portfolio itself functioned effectively, the university policies and technical requirements prevented serious use. The negative case analysis of the case study found revealed that Access and Control and Implementation, Technical and Policy Constraints protocols where limiting user uptake. From the semistructured interviews carried out as part of this study participant feedback revealed that whilst the participants did not use the ePortfolio system I designed, each student was employing Web 2.0 social networking and storage processes in their lives and research. In the subsequent iterations I then designed a more ‘ideal’ system that could be applied outside of the University context that draws upon the employment of these resources. In conclusion I suggest recommendations about ePortfolio design that considers what the applications of the theoretical protocols reveal about creative arts settings. The transferability of these recommendations are of course dependent upon the reapplication of the theoretical protocols in a new context. To address the mobility of ePortfolio design between Institutions and wider settings I have also designed a prototype for a business card sized USB portal for the artists’ ePortfolio. This research project is not a static one; it stands as an evolving design for a Web 2.0 ePortfolio that seeks to refer to users needs, institutional and professional contexts and the development of software that can be incorporated within the design. What it potentially provides to creative artist is an opportunity to have a dialogue about art with artefacts of the artist products and processes in that discussion.

Translation of addictions science into practice

Recent advances in the understanding of the genetic, neurochemical, behavioral and cultural underpinnings of addiction have led to rapid advances in the understanding of addiction as a disease. In fact, advances in basic science and the development of new pharmacological and behavioral therapies associated with them are appearing faster than can be assimilated not only by clinical researchers but practitioners and policy makers as well. Translation of science-based addictions knowledge into improved prevention, assessment and treatment, and communication of these changes to researchers and practitioners are significant challenges to the field. The general aim of this book is to summarize current and potential linkages between advances in addiction science and innovations in clinical practice. Whilst this book is primarily focused on translation, it also encompasses some scientific advances that are relevant to dissemination, and the book is itself a tool for disseminating innovative thinking. The goal is to generate interest in application opportunities from both recent research and theoretical advances.

Thinking spatially, acting collaboratively : a GIS-based health decision support system for improving the collaborative health-planning practice

The field of collaborative health planning faces significant challenges due to the lack of effective information, systems and the absence of a framework to make informed decisions. These challenges have been magnified by the rise of the healthy cities movement, consequently, there have been more frequent calls for localised, collaborative and evidence-driven decision-making. Some studies in the past have reported that the use of decision support systems (DSS) for planning healthy cities may lead to: increase collaboration between stakeholders and the general public, improve the accuracy and quality of the decision-making processes and improve the availability of data and information for health decision-makers. These links have not yet been fully tested and only a handful of studies have evaluated the impact of DSS on stakeholders, policy-makers and health planners. This study suggests a framework for developing healthy cities and introduces an online Geographic Information Systems (GIS)-based DSS for improving the collaborative health planning. It also presents preliminary findings of an ongoing case study conducted in the Logan-Beaudesert region of Queensland, Australia. These findings highlight the perceptions of decision-making prior to the implementation of the DSS intervention. Further, the findings help us to understand the potential role of the DSS to improve collaborative health planning practice.

The centrality of teachers’ judgement practice in assessment : a study of standards in moderation

There is a strong quest in several countries including Australia for greater national consistency in education and intensifying interest in standards for reporting. Given this, it is important to make explicit the intended and unintended consequences of assessment reform strategies and the pressures to pervert and conform. In a policy context that values standardisation, the great danger is that the technical, rationalist approaches that generalise and make superficial assessment practices, will emerge. In this article, the authors contend that the centrality and complexity of teacher judgement practice in such a policy context need to be understood. To this end, we discuss and analyse recorded talk in teacher moderation meetings showing the processes that teachers use as they work with stated standards to award grades (A to E). We show how they move to and fro between (1) supplied textual artefacts, including stated standards and samples of student responses, (2) tacit knowledge of different types, drawing into the moderation, and (3) social processes of dialogue and negotiation. While the stated standards play a part in judgement processes, in and of themselves they are shown to be insufficient to account for how the teachers ascribe value and award a grade to student work in moderation. At issue is the nature of judgement as cognitive and social practice in moderation and the legitimacy (or otherwise) of the mix of factors that shape how judgement occurs.

Pondering policy and parental perspectives : how parents view their role in shaping early childhood public policy

The focus of this paper is the role of Australian parents in early childhood education and care (ECEC), in particular, their role in shaping ECEC public policy. The paper reports the findings of a study investigating the different ways in which a group of parents viewed and experienced this role. Set against a policy backdrop where parents are positioned as 'consumers' and 'participants' in ECEC, the study employed a phenomenographic research approach to describe this role as viewed and experienced by parents. The study identified four logically related, qualitatively different ways of constituting this role among this group of parents, ranging from 'no role in shaping public policy' (the no role conception) to 'participating in policy decision-making, particularly where policy was likely to affect their child and family (the participating in policy decision-making conception). The study provides an insider-perspective on the role of parents in shaping policy and highlights variation in how this role is constituted by parents. The study also identifies factors perceived by parents as influencing their participation and discusses their implications for both policy and practice.

Best practice for prevention and treatment of cardiovascular disease through an equity lens : a review

Background: Despite declining rates of cardiovascular disease (CVD) mortality in developed countries, lower socioeconomic groups continue to experience a greater burden of the disease. There are now many evidence-based treatments and prevention strategies for the management of CVD and it is essential that their impact on the more disadvantaged group is understood if socioeconomic inequalities in CVD are to be reduced. Aims: To determine whether key interventions for CVD prevention and treatment are effective among lower socioeconomic groups, to describe barriers to their effectiveness and the potential or actual impact of these interventions on the socioeconomic gradient in CVD. Methods: Interventions were selected from four stages of the CVD continuum. These included smoking reduction strategies, absolute risk assessment, cardiac rehabilitation, secondary prevention medications, and heart failure self-management programmes. Electronic searches were conducted using terms for each intervention combined with terms for socioeconomic status (SES). Results: Only limited evidence was found for the effectiveness of the selected interventions among lower SES groups and there was little exploration of socioeconomic-related barriers to their uptake. Some broad themes and key messages were identified. In the majority of findings examined, it was clear that the underlying material, social and environmental factors associated with disadvantage are a significant barrier to the effectiveness of interventions. Conclusion: Opportunities to reduce socioeconomic inequalities occur at all stages of the CVD continuum. Despite this, current treatment and prevention strategies may be contributing to the widening socioeconomic-CVD gradient. Further research into the impact of best-practice interventions for CVD upon lower SES groups is required.

Examining the covert nature of product placement : implications for public policy

As consumers become better educated and more skeptical of traditional advertising, alternate forms of marketing communication have emerged that aim to influence audiences unobtrusively. One such example is product placement. Product placement has attracted ongoing debate as to whether it is covert, unethical, and influences consumption. The current article examines the nature and practice of product placement in this light. This taxonomy of product placement attributes is based on current marketing practice and examines whether this is, indeed, a covert marketing strategy. Further, it presents a conceptualization of the influence of product placement on consumer welfare. We highlight that the many forms of product placement necessitate independent evaluation to determine ethical and regulatory standards. Operational solutions for developing public policy are offered.

Female genital mutilation : Australian law, policy and practical challenges for doctors

As long ago as 1994, the Family Law Council accepted it was likely that female genital mutilation (FGM) was being conducted in Australia. In 2010, doctors and hospitals reported that it is being conducted and that they are seeing female patients who have experienced FGM. It is impossible to obtain precise data about the extent to which it is performed in Australia, but data indicates that FGM is a relevant issue for Australian medical practitioners. The medical profession has an interest in this topic because its members may be asked to conduct FGM, advise those considering it, or treat female patients with effects from the practice. This article provides a background on the practice of FGM, explains the relevant Australian law, considers whether the current legal prohibition on FGM is justified, and discusses the practical challenges facing individual practitioners and the profession. To inform further discussions about methods of responding to demand for FGM, reference is made to strategies being promoted in African nations to abolish this cultural practice.