Working at the nexus between public health policy, practice and research : dynamics of knowledge sharing in the Netherlands

Background
Joining the domains of practice, research and policy is an important aspect of boosting the quality performance required to tackle complex public health problems. “Joining domains” implies a departure from the linear and technocratic knowledge-translation approach. Integrating the practice, research and policy triangle means knowing its elements, appreciating the barriers, identifying possible cooperation strategies and studying strategy effectiveness under specified conditions.
This article examines the dynamic process of developing an Academic Collaborative Centre for Public Health in the Netherlands, with the objective of achieving that the three domains of policy, practice and research become working partners on an equal footing.
Method
An interpretative hermeneutic approach was used to interpret the phenomenon of collaboration at the nexus between the three domains. The project was explicitly grounded in current organizational culture and routines, applied to nexus action. In the process of examination, we used both quantitative (e.g. records) and qualitative data (e.g., interviews and observations). The data were interpreted using the Actor-Network, Institutional Re-Design and Blurring the Boundaries theories.
Results
Results show commitment at strategic level. At the tactical level, however, managers were inclined to prioritize daily routine, while the policy domain remained absent. At the operational level, practitioners learned to do PhD research in real-life practice and researchers became acquainted with problems of practice and policy, resulting in new research initiatives.
Conclusion
We conclude that working at the nexus is an ongoing process of formation and reformation. Strategies based on Institutional Re-Design theories in particular might help to more actively stimulate managers’ involvement to establish mutually supportive networks.

Factors to drive clinical practice improvement in a Malaysian intensive care unit : assessment of organisational readiness using a mixed method approach

This study assessed organisational readiness and factors to drive clinical practice improvement for VAP, CRBSI and PU in a Malaysian intensive care unit (ICU). A mixed method study approach was undertaken in a 16-bed ICU in regional Malaysia using an environmental scan, key informant interviews, staff surveys, and patient audit to elucidate factors contributing to planning for clinical practice improvement. Measurements of sustainability of practice and regard for the practice environment were assessed using validated measures. An environmental scan demonstrated high patient occupancy and case load. Nineteen percent of ICU patients developed complications according to validated measures. Survey results indicated that the majority of nurses had a good knowledge of strategies to prevent ICU complications and a positive attitude toward change processes. Engaging executive leadership was identified as crucial in priming the clinical site for practice change. Providing nurses with tools to monitor their clinical practice and empowering them to change practices are important in improving clinical outcomes.

“People’s law” and restorative justice: the success of circle sentencing in New South Wales

Informal sentencing procedures in remote Indigenous communities of Australia have been occurring for some time, but it was in the late 1990s that formalization of the practice began in urban areas with the advent of Indigenous sentencing and circle courts. These circle courts emerged primarily to address the over-representation and incarceration of Indigenous people in the criminal justice system. The first Indigenous urban court was assembled in Port Adelaide, South Australia in June 1999 and was named the Nunga Court. Courts emerging since in other states are based on the Nunga Court model, although they have been adapted to suit local conditions. The practice of circle sentencing was introduced in New South Wales (NSW) in Nowra in February 2002.

Analysis of psycholinguistic processes and topics in online autism communities

Current growth of individuals on the autism spectrum disorder (ASD) requires continuous support and care. With the popularity of social media, online communities of people affected by ASD emerge. This paper presents an analysis of these online communities through understanding aspects that differentiate such communities. In this paper, the aspects given are not expressed in terms of friendship, exchange of information, social support or recreation, but rather with regard to the topics and linguistic styles that people express in their on-line writing. Using data collected unobtrusively from LiveJournal, we analyze posts made by ten autism communities in conjunction with those made by a control group of standard communities. Significant differences have been found between autism and control communities when characterized by latent topics of discussion and psycholinguistic features. Latent topics are found to have greater predictive power than linguistic features when classifying blog posts as either autism or control community. This study suggests that data mining of online blogs has the potential to detect clinically meaningful data. It opens the door to possibilities including sentinel risk surveillance and harnessing the power in diverse large datasets.

Learning to reason: a journey of professional socialisation

One of the key attributes that health professional students and new graduates develop during professional socialisation is clinical reasoning ability. Clinical reasoning is a complex skill that is essential for professional practice. There is limited research specifically addressing how physiotherapists learn to reason in the workplace. The research reported in this paper addressed this gap by investigating how experienced physiotherapists learned to reason in daily practice. This learning journey was examined in the context of professional socialisation. A hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated, semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants' learning journeys were diverse, although certain episodes of learning were common or similar. Role models, mentors and colleagues were found to be influential in the development of reasoning. An important implication for the professional socialisation of physiotherapists and other health professionals and for those involved in practice development is the need to recognise and enhance the role of practice communities in the explicit learning of clinical reasoning skills.

Edge of centre: Australian cities and the public architecture of recent immigrant communities

In the late 1990s, the author undertook a survey of the public architecture of non-western immigrant communities in Melbourne (Beynon 2002). The survey was undertaken within a social context of rapid recent growth in non-Western immigration to Australian cities, coupled with a political context where at state and local level Australian governments were engaged in managing cultural diversity through multiculturalist policies. By the late 1990s, the number of overseas-born, or with overseas-born parentage, had become almost 40% of Australia's total population (Australian Bureau of Statistics 1998-89). Substantial numbers of such immigrants originated from outside the 'West'. Compared to other Australian cities, Melbourne had at the time of the survey the largest communities of certain birthplace groups: notably Sri Lankans, Malaysians, Turks and Somalis. The purpose of this survey was to see to what extent Melbourne's diversifying demography had changed its architectural landscape, and more broadly, what such changes in the built environment indicated about Melbourne's (and by extension Australia's) cultural identity.

Comparison of medication policies to guide nursing practice across seven Victorian health services

Objectives The objective of this paper is to review and compare the content of medication management policies across seven Australian health services located in the state of Victoria. Methods The medication management policies for health professionals involved in administering medications were obtained from seven health services under one jurisdiction. Analysis focused on policy content, including the health service requirements and regulations governing practice. Results and Conclusions The policies of the seven health services contained standard information about staff authorisation, controlled medications and poisons, labelling injections and infusions, patient self-administration, documentation and managing medication errors. However, policy related to individual health professional responsibilities, single- and double-checking medications, telephone orders and expected staff competencies varied across the seven health services. Some inconsistencies in health professionals' responsibilities among medication management policies were identified. What is known about the topic? Medication errors are recognised as the single most preventable cause of patient harm in hospitals and occur most frequently during administration. Medication management is a complex process involving several management and treatment decisions. Policies are developed to assist health professionals to safely manage medications and standardise practice; however, co-occurring activities and interruptions increase the risk of medication errors. What does this paper add? In the present policy analysis, we identified some variation in the content of medication management policies across seven Victorian health services. Policies varied in relation to medications that require single- and double-checking, as well as by whom, nurse-initiated medications, administration rights, telephone orders and competencies required to check medications. What are the implications for practitioners? Variation in medication management policies across organisations is highlighted and raises concerns regarding consistency in governance and practice related to medication management. Lack of practice standardisation has previously been implicated in medication errors. Lack of intrajurisdictional concordance should be addressed to increase consistency. Inconsistency in expectations between healthcare services may lead to confusion about expectations among health professionals moving from one healthcare service to another, and possibly lead to increased risk of medication errors.

The temptations and failings of teacher effectiveness research: provocations of a ‘practice perspective’

This chapter provides a critical appraisal of teacher effectiveness research (TER). Like others before us, we argue that TER employs a reductive view of teaching—narrowly focused on the agency of individual teachers’ classroom-based pedagogic behaviours; overemphasising the role these behaviours have on student achievement; representing these behaviours as assayable in unproblematic ways; and, potentially having negative impacts on teachers and teaching. We suggest that the theoretical sensibilities of practice theory support more productive engagements with the complexities of teaching, and we argue that this alternative theoretical framing is more likely to engage teachers in transformational agendas than those offered by current manifestations of TER. We do this by drawing on the practice writings of Reckwitz (2002), Thrift (1996, 2007) and Schatzki (2012), who provide analyses of commonalities to be found amongst diverse practice theories. We argue that a ‘practice perspective’ provides an affirmative engagement with the complexities of teaching practice and is more likely to embolden new interpretations of what teaching is and can be.