Advance Care Planning in palliative care : a systematic literature review of the contextual factors influencing its uptake 2008-2012

Background: Advance Care Planning is an iterative process of discussion, decision-making and documentation about end-of-life care. Advance Care Planning is highly relevant in palliative care due to intersecting clinical needs. To enhance the implementation of Advance Care Planning, the contextual factors influencing its uptake need to be better understood. Aim: To identify the contextual factors influencing the uptake of Advance Care Planning in palliative care as published between January 2008 and December 2012. Methods: Databases were systematically searched for studies about Advance Care Planning in palliative care published between January 2008 and December 2012. This yielded 27 eligible studies, which were appraised using National Institute of Health and Care Excellence Quality Appraisal Checklists. Iterative thematic synthesis was used to group results. Results: Factors associated with greater uptake included older age, a college degree, a diagnosis of cancer, greater functional impairment, being white, greater understanding of poor prognosis and receiving or working in specialist palliative care. Barriers included having non-malignant diagnoses, having dependent children, being African American, and uncertainty about Advance Care Planning and its legal status. Individuals’ previous illness experiences, preferences and attitudes also influenced their participation. Conclusion: Factors influencing the uptake of Advance Care Planning in palliative care are complex and multifaceted reflecting the diverse and often competing needs of patients, health professionals, legislature and health systems. Large population-based studies of palliative care patients are required to develop the sound theoretical and empirical foundation needed to improve uptake of Advance Care Planning in this setting.

Profiling contextual factors which influence safety in heavy vehicle industries

A significant proportion of worker fatalities within Australia result from truck-related incidents. Truck drivers face a number of health and safety concerns. Safety culture, viewed here as the beliefs, attitudes and values shared by an organisation’s workers, which interact with their surrounding context to influence behaviour, may provide a valuable lens for exploring safety-related behaviours in heavy vehicle operations. To date no major research has examined safety culture within heavy vehicle industries. As safety culture provides a means to interpret experiences and generate behaviour, safety culture research should be conducted with an awareness of the context surrounding safety. The current research sought to examine previous health and safety research regarding heavy vehicle operations to profile contextual factors which influence health and safety. A review of 104 peer-reviewed papers was conducted. Findings of these papers were then thematically analysed. A number of behaviours and scenarios linked with crashes and non-crash injuries were identified, along with a selection of health outcomes. Contextual factors which were found to influence these outcomes were explored. These factors were found to originate from government departments, transport organisations, customers and the road and work environment. The identified factors may provide points of interaction, whereby culture may influence health and safety outcomes.

Factors influencing paediatric nurses' responses to medication administration

Objective: To evaluate the importance of contextual and policy factors on nurses’ judgment about medication administration practice.---------- Design: A questionnaire survey of responses to a number of factorial vignettes in June 2004. These vignettes considered a combination of seven contextual and policy factors that were thought to influence nurses’ judgments relating to medication administration.---------- Participants: 185 (67% of eligible) clinical paediatric nursing staff returned completed questionnaires.--------- Setting: A tertiary paediatric hospital in Brisbane, Australia.---------- Results: Double checking the patient, double checking the drug and checking the legality of the prescription were the three strongest predictors of nurses’ actions regarding medication administration.--------- Conclusions: Policy factors and not contextual factors drive nurses’ judgment in response to hypothetical scenarios.

Factors affecting the motivation of TEFL academics in higher education in China

This study investigates the motivation of English language lecturers in a Chinese university. Recent studies have shown that low morale and job dissatisfaction are significant problems identified in lecturers who teach English in universities in China. Given the importance of teaching English as a second language in China, this problem has potentially significant ramifications for the nation’s future. Low staff morale is likely to be associated with less effective teaching and poor student learning outcomes. Although the problem is acknowledged, there has been limited research to understand the underlying contributing factors. To address this, a sequential explanatory mixed methods approach was adopted and implemented in two phases at a large regional university in Northern China. The participants in the main study were 100 lecturers from two colleges at this university. All of the lecturers were responsible for teaching English as a foreign language (TEFL); 50 were teaching English majors and 50 were teaching university students whose majors were not English. The research was informed by a synthesis of self determination theory and theories of organisational culture. The study found: 1) in contrast to previously reported studies, lecturers in this institution were in general autonomously motivated in teaching. 2) However, their level of motivation was influenced by their personal experiences and varied sense of competence, relatedness and autonomy. 3) In particular, personal experiences and contextual factors such as the influence of Chinese culture, societal context, and organisational climate were significant in regulating lecturers’ motivation to teach. The findings are significant for leaders in higher education who need to implement policies that foster effective work environments. The study has also provided insights into the capacity of self determination theory to explain motivation in a Chinese culture.

Primary classroom teachers' use of social and emotional wellbeing programs and the factors influencing program use

There has been a rapid escalation in the development and evaluation of social and emotional well-being (SEW) programs in primary schools over the last few decades. Despite the plethora of programs available, primary teachers’ use of SEW programs is not well documented in Australian schools, with even less consideration of the factors influencing program use. A cross-sectional survey was undertaken with primary classroom teachers across twelve schools in the Brisbane and Sunshine Coast Education Districts in Queensland, Australia, during 2005. A checklist of SEW programs and an audit of SEW practices in schools were employed to investigate the number, range and types of SEW programs used by primary classroom teachers and the contextual factors influencing program use. Whilst the majority of implementation studies have been conducted under intervention conditions, this study was designed to capture primary classroom teachers’ day-to-day use of SEW programs and the factors influencing program use under real-world conditions. The findings of this research indicate that almost three quarters of the primary classroom teachers involved in the study reported using at least one SEW program during 2005. Wide variation in the number and range of programs used was evident, suggesting that teachers are autonomous in their use of SEW programs. Evidence-based SEW programs were used by a similar proportion of teachers to non-evidence-based programs. However, irrespective of the type of program used, primary teachers overwhelmingly reported using part of a SEW program rather than the whole program. This raises some issues about the quality of teachers’ program implementation in real-world practice, especially with respect to programs that are evidence-based. A content analysis revealed that a wide range of factors have been examined as potential influences on teachers’ implementation of health promotion programs in schools, including SEW programs, despite the limited number of studies undertaken to date. However, variation in the factors examined and study designs employed both within and across health promotion fields limited the extent to which studies could be compared. A methodological and statistical review also revealed substantial variation in the quality of reporting of studies. A variety of factors were examined as potential influences on primary classroom teachers’ use of SEW programs across multiple social-ecological levels of influence (ranging from community to school and individual levels). In this study, parent or caregiver involvement in class activities and the availability of wellbeing-related policies in primary schools were found to be influential in primary classroom teachers’ use of SEW programs. Teachers who often or always involve parents or caregivers in class activities were at a higher odds of program use relative to teachers who never or rarely involved parents or caregivers in class activities. However, teachers employed in schools with the highest number of wellbeing-related policies available were at a lower odds of program use relative to teachers employed in schools with fewer wellbeing-related policies available. Future research should investigate primary classroom teachers’ autonomy and motivations for using SEW programs and the reasons behind the selection and use of particular types of programs. A larger emphasis should also be placed upon teachers not using SEW programs to identify valid reasons for non-use. This would provide another step towards bridging the gap between the expectations of program developers and the needs of teachers who implement programs in practice. Additionally, the availability of wellbeing-related school policies and the types of activities that parents and caregivers are involved with in the classroom warrant more in-depth investigation. This will help to ascertain how and why these factors influence primary classroom teachers’ use of SEW programs on a day-to-day basis in schools.

End-of-life care in the critical care setting : nurses' practices and factors affecting these practices

Background: Critical care units are designed and resourced to save lives, yet the provision of end-of-life care is a significant component of nursing work in these settings. Limited research has investigated the actual practices of critical care nurses in the provision of end-of-life care, or the factors influencing these practices. To improve the care that patients at the end of life and their families receive, and to support nurses in the provision of this care, further research is needed. The purpose of this study was to identify critical care nurses' end-of-life care practices, the factors influencing the provision of end-of-life care and the factors associated with specific end-of-life care practices. Methods: A three-phase exploratory sequential mixed-methods design was utilised. Phase one used a qualitative approach involving interviews with a convenience sample of five intensive care nurses to identify their end-of-life care experiences and practices. In phase two, an online survey instrument was developed, based on a review of the literature and the findings of phase one. The survey instrument was reviewed by six content experts and pilot tested with a convenience sample of 28 critical care nurses (response rate 45%) enrolled in a postgraduate critical care nursing subject. The refined survey instrument was used in phase three of this study to conduct a national survey of critical care nurses. Descriptive analyses, exploratory factor analysis and univariate general linear modelling was undertaken on completed survey responses from 392 critical care nurses (response rate 25%). Results: Six end-of-life care practice areas were identified in this study: information sharing, environmental modification, emotional support, patient and family-centred decision making, symptom management and spiritual support. The items most frequently identified as always undertaken by critical care nurses in the provision of end-of-life care were from the information sharing and environmental modification practice areas. Items least frequently identified as always undertaken included items from the emotional support practice area. Eight factors influencing the provision of end-of-life care were identified: palliative values, patient and family preferences, knowledge, preparedness, organisational culture, resources, care planning, and emotional support for nurses. Strong agreement was noted with items reflecting values consistent with a palliative approach and inclusion of patient and family preferences. Variation was noted in agreement for items regarding opportunities for knowledge acquisition in the workplace and formal education, yet most respondents agreed that they felt adequately prepared. A context of nurse-led practice was identified, with variation in access to resources noted. Collegial support networks were identified as a source of emotional support for critical care nurses. Critical care nurses reporting values consistent with a palliative approach and/or those who scored higher on support for patient and family preferences were more likely to be engaged in end-of-life care practice areas identified in this study. Nurses who reported higher levels of preparedness and access to opportunities for knowledge acquisition were more likely to report engaging in interpersonal practices that supported patient and family centred decision making and emotional support of patients and their families. A negative relationship was identified between the explanatory variables of emotional support for nurses and death anxiety, and the patient and family centred decision making practice area. Contextual factors had a limited influence as explanatory variables of specific end-of-life care practice areas. Gender was identified as a significant explanatory variable in the emotional and spiritual support practice areas, with male gender associated with lower summated scores on these practice scales. Conclusions: Critical care nurses engage in practices to share control with and support inclusion of families experiencing death and dying. The most frequently identified end-of-life care practices were those that are easily implemented, practical strategies aimed at supporting the patient at the end of life and the patient's family. These practices arguably require less emotional engagement by the nurse. Critical care nurses' responses reflected values consistent with a palliative approach and a strong commitment to the inclusion of families in end-of-life care, and these factors were associated with engagement in all end-of-life care practice areas. Perceived preparedness or confidence with the provision of end-of-life care was associated with engagement in interpersonal caring practices. Critical care nurses autonomously engage in the provision of end-of-life care within the constraints of an environment designed for curative care and rely on their colleagues for emotional support. Critical care nurses must be adequately prepared and supported to provide comprehensive care in all areas of end-of-life care practice. The findings of this study raise important implications, and informed recommendations for practice, education and further research.

Modelling the salient factors influencing retired business professionals' participation in episodic skilled volunteering in rural settings

Retired business professionals represent an unexplored source of skill support for struggling rural communities. This research examined the feasibility of drawing on this valuable pool of knowledge and experience by engaging retirees in short term, project based volunteering roles in rural, not for profit agencies. Using the theory of planned behaviour and the functional approach to volunteering, the program of study generated a model comprising the key psychological and contextual factors determining the volunteers' decision to provide skill assistance in rural settings. The model provides a useful resource for creating suitable volunteering opportunities and for informing volunteer recruitment strategies.

A cloud-based intelligent computing system for contextual exploration on personal sleep-tracking data using association rule mining

With the development of wearable and mobile computing technology, more and more people start using sleep-tracking tools to collect personal sleep data on a daily basis aiming at understanding and improving their sleep. While sleep quality is influenced by many factors in a person’s lifestyle context, such as exercise, diet and steps walked, existing tools simply visualize sleep data per se on a dashboard rather than analyse those data in combination with contextual factors. Hence many people find it difficult to make sense of their sleep data. In this paper, we present a cloud-based intelligent computing system named SleepExplorer that incorporates sleep domain knowledge and association rule mining for automated analysis on personal sleep data in light of contextual factors. Experiments show that the same contextual factors can play a distinct role in sleep of different people, and SleepExplorer could help users discover factors that are most relevant to their personal sleep.

The effect of gender context on children's social behaviour in a limited resources situation : an observational study

Knowing when to compete and when to cooperate to maximize opportunities for equal access to activities and materials in groups is critical to children's social and cognitive development. The present study examined the individual (gender, social competence) and contextual factors (gender context) that may determine why some children are more successful than others. One hundred and fifty-six children (M age=6.5 years) were divided into 39 groups of four and videotaped while engaged in a task that required them to cooperate in order to view cartoons. Children within all groups were unfamiliar to one another. Groups varied in gender composition (all girls, all boys, or mixed-sex) and social competence (high vs. low). Group composition by gender interaction effects were found. Girls were most successful at gaining viewing time in same-sex groups, and least successful in mixed-sex groups. Conversely, boys were least successful in same-sex groups and most successful in mixed-sex groups. Similar results were also found at the group level of analysis; however, the way in which the resources were distributed differed as a function of group type. Same-sex girl groups were inequitable but efficient whereas same-sex boy groups were more equitable than mixed groups but inefficient compared to same-sex girl groups. Social competence did not influence children's behavior. The findings from the present study highlight the effect of gender context on cooperation and competition and the relevance of adopting an unfamiliar peer paradigm when investigating children's social behavior.

Exploring the influence of a science content course incorporating explicit nature of science and argumentation instruction on preservice primary teachers' views of nature of science

There exists a general consensus in the science education literature around the goal of enhancing students. and teachers. views of nature of science (NOS). An emerging area of research in science education explores NOS and argumentation, and the aim of this study was to explore the effectiveness of a science content course incorporating explicit NOS and argumentation instruction on preservice primary teachers. views of NOS. A constructivist perspective guided the study, and the research strategy employed was case study research. Five preservice primary teachers were selected for intensive investigation in the study, which incorporated explicit NOS and argumentation instruction, and utilised scientific and socioscientific contexts for argumentation to provide opportunities for participants to apply their NOS understandings to their arguments. Four primary sources of data were used to provide evidence for the interpretations, recommendations, and implications that emerged from the study. These data sources included questionnaires and surveys, interviews, audio- and video-taped class sessions, and written artefacts. Data analysis involved the formation of various assertions that informed the major findings of the study, and a variety of validity and ethical protocols were considered during the analysis to ensure the findings and interpretations emerging from the data were valid. Results indicated that the science content course was effective in enabling four of the five participants. views of NOS to be changed. All of the participants expressed predominantly limited views of the majority of the examined NOS aspects at the commencement of the study. Many positive changes were evident at the end of the study with four of the five participants expressing partially informed and/or informed views of the majority of the examined NOS aspects. A critical analysis of the effectiveness of the various course components designed to facilitate the development of participants‟ views of NOS in the study, led to the identification of three factors that mediated the development of participants‟ NOS views: (a) contextual factors (including context of argumentation, and mode of argumentation), (b) task-specific factors (including argumentation scaffolds, epistemological probes, and consideration of alternative data and explanations), and (c) personal factors (including perceived previous knowledge about NOS, appreciation of the importance and utility value of NOS, and durability and persistence of pre-existing beliefs). A consideration of the above factors informs recommendations for future studies that seek to incorporate explicit NOS and argumentation instruction as a context for learning about NOS.

Leadership construction : an exploratory case study of two exemplary female principals in urban primary schools in mainland China

Worldwide, education systems have undergone unprecedented change due to a variety of economic, social, and political forces (Limerick, Cunnington & Crowther, 2002). The People’s Republic of China (PRC) is no exception. Continuous educational reform at primary and secondary levels in Mainland China has created new challenges and accountabilities for school principals. The important role of principals in primary and secondary schools has been acknowledged in both policy documents and the broader literature (Central Committee of the Chinese Communist Party, 1985; F. Chen, 2005; Chu, 2003; W. Huang, 2005; T. Wang, 2003). Yet, most of the literature on primary and secondary school principals in Mainland China is prescriptive in nature, identifying from the perspectives of researchers and academics what principals should do and how they should enact leadership. Lacking in this research is an awareness of the daily practices and lived experiences of principals. Furthermore, within the small body of writing on primary and secondary school principals in Mainland China, gender is seldom given any attention. To date, only a small number of empirical studies have focused on female principals as a specific category of research (Zen, 2004; Zhong, 2004). This study aimed to explore the professional lives of two female exemplary school principals in urban primary schools in Mainland China. A qualitative exploratory case study was used. Semi-structured interviews with each individual female principal, with six teachers in each of the school sites and with the superintendent of each principal were conducted. Field observations and document analysis were also undertaken to obtain multiple insights about their leadership practices. The conceptual framework was based largely on the theory of Gronn (1999) and incorporated five core leadership practices (vision building, ethical considerations, teaching and learning, power utilisation, and dealing with risks and challenges) taken from the wider literature. The key findings of this study were twofold. Firstly, while the five leadership practices were evident in the leadership of the two principals, this study identified some subtle differences in the way they approached each of them. Secondly, contextual factors such as Chinese traditional culture, the contemporary societal context, and the school organisational context, in addition to the biographical experiences of each principal were significant factors in shaping the way in which they exercised their leadership practices in the schools.

Ties that blind? How strong ties affect small business owner-managers’ perceived trustworthiness of their advisors

This research investigates how a strong personal relationship (strong tie) between a small business owner-manager and his professional or informal advisor affects the relationship between the advisor's recent performance and the owner-manager's perceptions of the advisor's trustworthiness in terms of ability, benevolence and integrity. A negative moderating effect could point to a 'tie that blinds': the owner-manager may be less critical in evaluating the advisor's perceived trustworthiness in light of their recent performance, because of the existing personal relationship. A conceptual model is constructed and examined with survey data comprising 153 young Finnish businesses. The results show that strong ties increase the owner-manager's perception of the advisor's integrity, disregarding their recent performance. For professional advisors, strong ties reduce the impact of recent performance in the owner-manager's evaluation of their ability. For informal advisors, a strong tie makes it more likely that their benevolence will be evaluated highly in light of their recent performance. While the results show that 'ties can blind' under certain circumstances, the limitations of the study raise the need for further research to specify these contextual factors and examine the causal link between the choice of advisor and business performance.

Modelling the process of learning in economics

Student learning research literature has shown that students' learning approaches are influenced by the learning context (Evans, Kirby, & Fabrigar, 2003). Of the many contextual factors, assessment has been found to have the most important influence on the way students go about learning. For example, assessment that is perceived to required a low level of cognitive abilities will more likely elicit a learning approach that concentrate on reproductive learning activities. Moreover, assessment demand will also interact with learning approach to determine academic performance. In this paper an assessment specific model of learning comprising presage, process and product variables (Biggs, 2001) was proposed and tested against data obtained from a sample of introductory economics students (n=434). The model developed was used to empirically investigate the influence of learning inputs and learning approaches on academic performances across assessment types (essay assignment, multiple choice question exam and exam essay). By including learning approaches in the learning model, the mechanism through which learning inputs determine academic performance was examined. Methodological limitations of the study will also be discussed.

An exploration of two female principals’ leadership in mainland China

Purpose: The purpose of this paper is to explore two dimensions of leadership practices (i.e. teaching and learning and sources of power) used by two exemplary principals in mainland China against a background of education reform and to identify how broader contextual factors have shaped these two dimensions of their leadership.--------- Design/methodology/approach: An exploratory case study was used that drew upon semi-structured interviews, observations and document analysis. Interviews were conducted with two principals, six teachers from each of the two schools and a superintendent who was the supervisor of the two principals.---------- Findings: The findings reveal that there are some common elements in both of the leaders’ practices but also some subtle differences. Both leaders emphasise teaching and learning. One sees herself as curriculum expert; the other delegate teaching responsibilities. While both uses a top down approach, one principal uses an adversarial approach and the other a more facilitative approach.---------- Research limitations/implications: The study used a small sample size. It explored the leaders’ practices in the light of broader contextual factors rather than personal factors or gender-based factors Originality/value – Given the limited empirical research conducted on female principals in mainland China, this qualitative study provides insights into two dimensions of leadership used by two exemplary principals and explains their practices in the light of critical contextual factors such as contemporary and traditional Chinese culture and the school’s organisational context.

Enterprise systems in universities : a teaching case

This teaching case aims to contribute to understanding the phenomenon of Enterprise Systems (ES) implementations in universities. Through this case, students will gain understanding of the importance of ‘contextual elements’ for large scale information systems (IS) implementations, in particular ES. This teaching case illustrates how these contextual factors contribute to the success or failure of such implementations, and how they can influence the decisions that dictate the lifecycle of such systems. The case describes ES implementations at a leading Australian university, and presents a rich account of the institutional, national and industry-sector contexts that have influenced the directions and decisions taken. The journey encountered with the main Enterprise Systems that support Financials, Human Resources and Facilities are described suggesting the lifecycle phases, critical success factors and lessons learnt.