Acute pain management: Implications of scientific evidence for nursing practice in the postoperative context

Unrelieved acute pain remains prevalent in hospitalized patients despite advances in pain management. A decade after the Australian National Health and Medical Research Council called for improved pain management practices by health professionals, it released clinical guidelines to provide clinicians with current scientific evidence to augment their clinical decision-making. This paper examines the implications of national guidelines on nursing practice and highlights the inadequacies of current implementation policies. Pain management guidelines have failed to decrease patients' postoperative pain because organizations and researchers have ignored the impact of contextual influences on clinicians' decision-making. It is recommended that for successful implementation of national guidelines to occur at the local level of practice, organizations must assist clinicians to identify local influences on their decision-making, to address the issues specific to their own work environment and to evaluate any changes in practice.

Development of an instrument for the analysis of problem gambling counselling practice

This article provides an overview of the development and validation of a Counsellor Task Analysis (Problem Gambling) [CTA (PG)] instrument undertaken in order to document the activities of counsellors in problem gambling services. The CTA (PG) aims to provide a broad overview of the complexity of the counsellor's role; specify the range of tasks they perform; and document the relationship between the frequency of task performance and the counsellor's beliefs about the importance of the tasks performed.

The CTA (PG) instrument addresses nine dimensions of practice activity through nine subscales, all of which demonstrate internal consistency. It appears to be a strong instrument in terms of its measurement error characteristics for recommending its use with counsellors engaged in the field of gambling. The CTA (PG) gives counsellors the opportunity to document their practice and theories in use when dealing with a problem gambler, a member of the problem gambler's family and the community at large. The psychometric findings reported in this article should be viewed as the preliminary results of an ongoing research effort and further psychometric testing is anticipated.

Whose homework? researching parental labour in socio-economically diverse communities

Recent government education policies in Britain, USA and Australia advocate increased parental involvement in schooling. In the context of inadequate resourcing of public schools, increasingly parents assume significant responsibility for their children's education through active involvement in schools and at home. However, numerous studies have identified barriers to inclusion in the life of schools faced by families living in poverty, by families whose first language is not English, by Indigenous families. Class linked analyses of homework suggest that homework can be a source of stress in many families which serves to reinforce educational and social inequalities and underline cultural differences.


This paper reports on a feminist ethnographic study of homework which examines the nature and underlying purposes of tasks children bring from school for completion at home, the impact of homework on families, and the kinds of parental labour performed in homes where homework is completed. It reconceptualises homework as a 'field of practice' and develops a Bourdiueian analysis of parental management of homework across 2 socio-economically diverse communities. The paper argues that the pedagogical work in the home is increasingly complex and that the labour performed by parents is misunderstood and devalued in policies which shape homework.

Procedural trained, procedural remain : the first report from 'A census of doctors who have been awarded the Graduate Diploma in Rural General Practice (GDRGP)'

Aims & rationale/Objectives : To document the practice of initial cohorts receiving the Graduate Diploma in Rural General Practice
Methods : With the co-operation of the National Rural Faculty (NRF) of Royal Australian College of General Practitioners (RACGP), a census by questionnaire was conducted on 279 graduates. The response rate was 70%.
Principal findings : The target doctors are young (65% < 40 years old). Under half (42.3%) have completed Advanced Rural Skills terms in >1 discipline. Of the total 272 posts recorded from 174 respondents, the most popular advanced skill is anaesthetics, followed by obstetrics. The ARSP increased confidence in 96.3% of respondents. Two thirds of doctors trained in a procedural skill remain practicing procedural General Practice.
Discussion : The GDRGP was the qualification developed to recognise competency gained as a result of a series of rural training initiatives begun within the RACGP Training Program in 1992. Its delivery has continued under the new GPET Training Program. Outcomes from the range of initiatives leading to the GDRGP are currently emerging in an environment which has seen significant changes within vocational training, and within the context of a rising focus on indemnity. Doctors who undertook this training have mostly retained procedural practice. In addition, RACGP rural initiatives successfully achieved increase confidence prior to rural work in advanced areas of practice, with >95% reporting an increase.
Implications : Changes within vocational training were accelerated without analysis of existing initiatives such as the GDRGP. Funding for the GDRGP was, as a result, withdrawn prematurely. These changes also saw the entrant of a second College with an interest in rural procedural practice. This research show that the GDRGP offers, and offered, a clear vocational pathway that will guide a doctor to a career as a rural doctor, and provide them with the advanced skills they need to practice confidently in the bush. It is important to capitalise on past success before deconstructing professional concepts of practice further.
Presentation type : Paper

The effect of using trained versus untrained adult respondents in simulated practice interviews about child abuse

Objective
A single study tested the hypothesis that simulated practice interviews for investigative interviewers of children are more effective when the role of the child respondent is played by trained actors (i.e., postgraduate psychology students) than untrained fellow participants (i.e., child protection workers).
Method
The interviewers included 50 child protection service workers. Each interviewer received instruction in the use of open-ended questions and then engaged in two simulated practice interviews. The role of the child respondent in the practice interviews was played by either a trained psychology student or an untrained fellow participant. The key outcome measure was the proportion of open-ended questions, which was assessed immediately prior to and after the practice sessions, as well as 12 weeks post-training.
Results
Interviewers who had practiced with trained actors had higher post-training performance (M = .83, SD = .12) compared to those who had practiced with untrained fellow participants (M = .73, SD = .13, p < .05), even at the 12-week follow up (M actors = .66, SD = .25; M untrained actors = .49, SD = .23, p < .05).
Conclusions
Training programs that make better use of practice opportunities (e.g., by using trained respondents) will be more effective in improving the performance of investigative interviewers.
Practice implications
A single study investigated the relative effectiveness of two simulated practice exercises for professionals who interview children about abuse. This research is relevant to professionals who design investigative interviewer training programs because it indicates that practical exercises, which are currently chosen on an ‘ad hoc’ or convenience basis, can vary markedly in their effectiveness in encouraging adherence to open questions.

Development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand

This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand District Health Board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.

An evaluation of a self-intiated practice exercise for investigative interviewers of children

The current study extends debate and research on the important role of practice in promoting and sustaining complex skills in investigative interviewing. Specifically, we explored the use of self-initiated practice as one avenue for facilitating ongoing development of professionals who interview children about abuse. A group of 40 investigative interviewers were required to organise and administer their own practice opportunities and to document these sessions in a diary. The professionals were aware of the important role of practice and what constitutes best-practice interview guidelines; however no instruction was given about the desired format, structure and timing of the practice sessions. A combination of quantitative and qualitative analyses revealed poor adherence to self-initiated practice, and the practice (among those who adhered to this model) had negligible impact on performance. Overall, these findings highlight the need for careful monitoring and evaluation of all interviewer practice tasks.

Knowing practice in English teaching? Research challenges in representing the professional practice of English teachers

This article problematises representations of professional practice. It investigates assumptions behind received accounts of professional practice, including professional standards that purportedly capture what accomplished English teachers “should know and be able to do”, “scientific” studies that construct accounts of classrooms from the standpoint of academic researchers, and narratives written by teachers that claim to explore dimensions of classroom teaching that elude outside observers. Especially significant are attempts by practitioner researchers to develop accounts of their professional practice vis-a-vis constructions of their work from other standpoints. We argue that it is timely for practitioner researchers to reflexively examine the conditions for producing such accounts, and to address the question of the validity of their knowledge claims. Yet this is also – crucially – more than an epistemological issue, but one that requires acknowledging the primacy of practice for engaging with the complexities of classroom settings. This article gives an account of our ongoing efforts to develop forms of representation that might begin to do justice to the complexities of practice in comparison with accepted accounts of what English teachers know and do. We intend it to be read as a position paper which outlines a framework for research on English teaching as a dynamic culture practice.

Deep identity, shallow time : sustaining a future in Victorian fishing communities

Like commercial fishers everywhere, it seems, those living in coastal communities of Victoria perceive themselves to be under threat from recreational fishers, environmentalists, imposed management regimes, and modernisation and globalisation of the industry. In responding to these threats they appeal to conventional props of tradition--to continuity in genealogical time, affiliation with place and specialised knowledge and practice. This seems paradoxical, given that most established fishers in Victoria are first or second generation members of an industry that, through its 150-year history, has been characterised by innovation and mobility. That paradox, we argue, is more apparent than real. Fisher identity is grounded primarily in engagement with an environment that is not familiar to outsiders. The paradox arises because fishers, like others who seek to sustain a future in the face of threat from outsiders, reshape strongly felt identity as tradition.

Understanding the mediatisation of educational policy as practice

The main argument presented in this paper is that the mediatisation of education should be viewed as forms of practice linked to specific practice effects. Drawing on Bourdieu's conceptualisation of practice - as elements of practice, practice games and field effects - the paper argues that viewing mediatisation as practice provides a set of methodological starting points for research involving media interactions with education. Taking the mediatisation of education policy as an empirical case for the argument, the contribution of the paper is to raise questions about how the term is utilised in educational research and to suggest that the practice is more open and complex than some accounts suggest. A secondary argument presented in this paper is that Bourdieu's account of practice provides resources suitable to developing research on mediatisation as an addition to social field theorising of processes.

Practice chains of production and consumption : mediatized practices across social fields

The argument developed in this paper is that a focus on practice provides some resolutions to methodological problems facing Bourdieuian scholarship in education. In order to develop Bourdieu's work on practice to account for the interactions between practices, this paper presents a conceptualization of practice as chains of production and consumption. The first part of the paper reviews the account of practice offered by Bourdieu both embedded in practice games and as field effects. The second part of the paper introduces practice chains of production and consumption as a way to conceptualize practice by drawing on a case involving print journalists' involvement with policy makers over the course of an Australian policy review. The final section presents a discussion of this conceptualization and highlights the potential of the concept for further research in understanding the processes of educational policy development.

Policy, practice and purpose in the field of education : a critical review

This paper provides a critical review of papers in this special issue on Bourdieu and practice. What is different about this collection is that, in analysing policy and practice through a Bourdieusian lens, the thinking tools of field, disposition (collective and individual), logics of practice and doxa have been mobilised with regard to the social practices of educational policy - its production, circulation and reception. First, these papers illustrate how, as a field, education has its own language, boundaries and power relations informed by particular modes of distinction and legitimation around different forms of capital formation, thus providing explanations for both social mobility and social stratification. Second, this collection foregrounds 'policy as practice' in terms of the social practices involved in the production of policy, the practices involved with the articulation and vernacularisation of policy through the processes of its reception, as well as the intent and effects of policy changing practice. Third, in focusing on specific policy problematics in higher education and schools, teacher professional development, leadership and educational reform, these contributions illustrate multiple methodological approaches as to how Bourdieu's thinking tools can be used to theorise educational policy, change, practice and effects. The value of Bourdieu's work lies on getting past the impasses between divisions between material and cultural analyses, between the materialist and linguistic focus, by talking about social practices, what people are doing, how they are thinking and how they are acting.

The TrueBlue study : is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes?

Background: In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD.

Methods: This is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs) will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses.

Conclusion: The strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for physiological, lifestyle and psychological risk factors for high-risk patients with co-morbid depression, diabetes or heart disease. The study will demonstrate whether nurse-led collaborative care achieves better outcomes than usual care.

Emergence of creativity in learning via social technologies

Creativity is an elusive skill desired by many. Debates on 'What is Creativity' and how it can best be nurtured and supported had resurgence in the 1950's after Guildford's address to the American Psychology Association about the positive benefits of creativity. Since then creativity has been investigated in many forms and within many disciplines. Of note is that creativity is apparent within four components: the person, the process, the product and the environment. On some level creativity is assessed within one of the four components of creativity: person, process, product or environment. In this study creativity and the environment is under investigation, with a number of factors presented that allow creativity to be supported. This paper explores the role of creativity within the education of tertiary students studying Games Design and Development (within an IT discipline) from an Australian University. Particularly this paper focuses on how social factors, such as purpose built collaborative environments and virtual communities, aid in the creative pursuits of the students.

The use of heuristics in valuation practice : implications in a changing market

Despite the existence of prescribed frameworks, valuation remains a cause of much controversy and variety of opinion. It does not matter whether procedures are undertaken in exactly the same way, the conclusion of ‘value’ will vary from valuer to valuer – sometimes considerably. This uncertainty within valuation is founded on property’s heterogeneous nature and the imperfect market that is the property market; in addition to the unpredictability of human behaviour in making judgements (French and Gabrielli 2004). Uncertainty, in valuation is found in the amalgam of locational, physical and legal characteristics and innumerable other forces which control and energise the property market (Whipple 1995). Particular irregular occurrences, or drastic changes in property markets, from either within market evolution or external forces, for example the creation of global financial markets, cause further uncertainty for valuers and provides challenges in identifying ‘market value’ in valuation practice. The praxis of valuation in a commercial sense navigates this complexity using a combination of algorithms and heuristics to identify the value of a property. The application of theoretical mathematical algorithms based on economic theory (Brown 1995), is augmented by valuers’ ability to apply appropriate adjustment based on their knowledge of the market, their ability to analyse, assess and compare the attributes of a property in comparison to its market, and their practical experience (Sliogeriene 2008). Despite the necessity of algorithms, the application of appropriate adjustments and assumptions are important in arriving at a value. This paper is a critical reflection on the basis of valuation practice as guided by standards, methods, and ethics (algorithms), and the use of heuristics in practice. This is important because changes within property markets challenge the inter-relationship between these two aspects of valuation practice. Through the authors’ industry experience and a review of previous research and statements of practice norms this paper provides an analysis of the ability of valuers to address market change in their valuation practices.