Is there a Plan B?: Clinical educators supporting underperforming students in practice settings

The relationship between supervisors and students in work-based clinical settings is complex, but critical to the appropriate development of the learner. This study investigated the experiences of physiotherapy clinical educators of working with underperforming students, and specifically explored educational strategies used with this subgroup of learners. Findings indicated the cyclical relationship between clinical educator's stressful experiences of working in multifaceted roles within a clinical environment and their tendencies to provide 'more more more' - more of the same strategies, more feedback and supervision, and more of themselves - as their primary approach to supporting underperforming students. The data suggest that clinical educators did not have an alternative ('Plan B') if the 'more more more' approach did not produce results. We argue that the problem of managing underperforming students is a complex one without easy solutions but a focus on systems changes rather than upon individual students or clinical educators should be considered.

Autism blogs: expressed emotion, language styles and concerns in personal and community settings

The Internet has provided an ever increasingly popular platform for individuals to voice their thoughts, and like-minded people to share stories. This unintentionally leaves characteristics of individuals and communities, which are often difficult to be collected in traditional studies. Individuals with autism are such a case, in which the Internet could facilitate even more communication given its social-spatial distance being a characteristic preference for individuals with autism. Previous studies examined the traces left in the posts of online autism communities (Autism) in comparison with other online communities (Control). This work further investigates these online populations through the contents of not only their posts but also their comments. We first compare the Autism and Control blogs based on three features: topics, language styles and affective information. The autism groups are then further examined, based on the same three features, by looking at their personal (Personal) and community (Community) blogs separately. Machine learning and statistical methods are used to discriminate blog contents in both cases. All three features are found to be significantly different between Autism and Control, and between autism Personal and Community. These features also show good indicative power in prediction of autism blogs in both personal and community settings.

Reasons for including multiage settings in teacher preparation

Teaching is a complex and cognitively demanding exercise where teachers need to draw on their expertise in a contextually-sensitive manner. Multiage settings that comprise students with widely different abilities, ages, and cognitive and linguistics capabilities, require teachers to develop and upgrade specific pedagogic and administrative skills. Teacher education programmes offered at Australian universities however are yet to fully recognise this need. In this paper, the author develops an argument for inclusion of specific training in multiageeducation in Australian teacher education programmes.

Nurses' documentation of physiological observations in three acute care settings

AIMS AND OBJECTIVES: To explore nurses' documentation of physiological observations in acute care; emergency department, medical and surgical units. BACKGROUND: In Australia, physiological observations include respiratory rate, oxygen saturation, heart rate, blood pressure, temperature and level of consciousness. There is a clear relationship between abnormal physiological observations and adverse events. Nurses have highest level of responsibility for accurate measurement, interpretation and documentation of physiological observations. DESIGN: A descriptive exploratory design was used and the study data were collected using a prospective point prevalence approach between 25 July 2012-22 August 2012. METHODS: The study was conducted in the emergency department, two 30-bed medical units and one 30-bed surgical unit of a 578 bed public health service in Melbourne, Australia. All adult patients aged ≥18 years present during data collection periods were eligible for inclusion. Patients in the emergency department resuscitation area were excluded. Patient characteristics and physiological observations for the preceding 24 hours in ward patients or eight hours in emergency department patients were collected. RESULTS: One hundred and seventy-eight patients were included; 38 emergency department patients, 84 medical patients and 56 surgical patients. The median age was 72·5 years and 43·8% were males. The most frequently documented physiological observations were respiratory rate, oxygen saturation, heart rate and systolic blood pressure. The least frequently recorded physiological observations were temperature and conscious state. One or more abnormal physiological parameters was documented in 79·8% (n = 142) patients; evidence of reporting abnormalities was documented in 19·7% of patients (n = 28/142). When controlled for length of stay, physiological observations were more frequently documented in the emergency department. CONCLUSIONS: There was variability in the number of parameters documented and frequency of physiological observations documented by nurses. RELEVANCE TO CLINICAL PRACTICE: Physiological abnormalities that do not necessarily fulfil rapid response team activation criteria are common in acute care patients and provide nurses with an opportunity for early recognition of deteriorating patients.

How the observed create ethical dilemmas for the observers: experiences from studies conducted in clinical settings in the UK and Australia

Observational research has a history of controversy, particularly when the research is conducted in a clinical setting. Existing ethical approval processes focus on protecting participants and the researcher's responsibilities, in particular where vulnerable populations are concerned. In this study, the authors explored the less overt and often understated ethical challenges that can arise when conducting observational research in a clinical setting. Reflecting on two recent studies conducted in different clinical settings, the authors described the challenges of blurring role boundaries, the risk of collecting redundant data, and the impact of reverse power relationships between researchers, clinicians, and managers. From their experiences, the authors suggested that the preparatory work undertaken with clinicians and managers onsite, which typically focuses on how the researchers will maintain the ethical robustness of the research and protect the rights of participants and the vulnerable, should also highlight the sometimes overlooked ethical issues associated with participatory research. This can help ensure that participants and managers understand the scope and limitations of the research, and consider the ways in which the observed can influence the researcher and the findings.

New Chinese entrepreneurs: perspectives of Confucian attributes and social settings

This chapter uses a qualitative approach to explore the characteristics of newly-bred Chinese entrepreneurs among 14 technology-based companies in Mainland China, Taiwan, and Hong Kong. Internal and external perspectives on studying entrepreneurship were adapted to examine personality attributes and the impacts of social settings on shaping the characteristics of modern Chinese entrepreneurs. The findings show that Chinese entrepreneurs were strongly influenced by the Confucianism, in which learning was upheld as a key to develop internal innovative capabilities for sustaining enterprise growth in the dynamic environment. Chinese entrepreneurs leading technologically innovative companies were also found to be visionary, but with less risk taking; they had exceptional networking capability and political dexterity to build strong relationships with government, industry and community. The tie between the Confucian entrepreneurial attributes and strong government support appears to enable the 'innovation in Chinese way'. Implications of these results are discussed.

Medical-legal partnerships: the role of mental health providers and legal authorities in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural settings

INTRODUCTION: Medical-legal partnerships (MLP) are a model in which medical and legal practitioners are co-located and work together to support the health and wellbeing of individuals by identifying and resolving legal issues that impact patients' health and wellbeing. The aim of this article is to analyse the benefits of this model, which has proliferated in the USA, and its applicability in the context of rural and remote Australia.

METHODS: This review was undertaken with three research questions in mind: What is an MLP? Is service provision for individuals with mental health concerns being adequately addressed by current service models particularly in the rural context? Are MLPs a service delivery channel that would benefit individuals experiencing mental health issues?

RESULTS: The combined searches from all EBSCO Host databases resulted in 462 citations. This search aggregated academic journals, newspapers, book reviews, magazines and trade publications. After several reviews 38 papers were selected for the final review based on their relevance to this review question: How do MLPs support mental health providers and legal service providers in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural Australia?

CONCLUSIONS: There is considerable merit in pursuing the development of MLPs in rural and remote Australia particularly as individuals living in rural and remote areas have far fewer opportunities to access support services than those people living in regional and metropolitan locations. MLPS are important channels of service delivery to assist in early invention of legal problems that can exacerbate mental health problems.

Metaphor as a methodological tool : identifying teachers’ social justice dispositions across diverse secondary school settings

This article investigates the social justice dispositions of teachers and principals in secondary schools as inferred from their metaphoric expressions. Drawing on a Bourdieuian account of disposition, our focus is the use of metaphor as a methodological tool to identify and reveal these otherwise latent forces within our data. Our analysis shows evidence of redistributive, recognitive and activist conceptions of social justice. We argue that these three social justice dispositions may be insufficient to meaningfully address persisting inequalities in the school system and that a capability-based social justice disposition – absent in our data – is needed. We conclude by highlighting that: social justice dispositions can change; a valid interpretation of metaphors requires ‘contextual stabilization’; and metaphors for social justice are differently constructed in different contexts, influenced by the different social, cultural and material conditions of schools.

Have adults lost their sense of play? An observational study of the social dynamics of physical (in)activity in German and Hawaiian leisure settings

BACKGROUND: Physical inactivity is one of the biggest health problems nowadays. Recent research shows that socio-cultural barriers to physical activity are mostly related to modern lifestyles. However, there is a lack of research on how social and group dynamics influence engagement in physical activity. Furthermore, there are few cross-cultural studies that have compared the social dynamics of (in)activity in different cultural settings. This paper therefore aims to analyse how social group dynamics influence physical activity and inactivity in informal social environments and whether physical activity is influenced by the socio-cultural settings. METHODS: The paper presents the qualitative data collected within a covert participant observation study. Data was collected by keeping observational notes in order to record typical, regular patterns regarding physical (in)activity related behaviour of groups at an artificial open air swimming pool in Germany and a natural pond in Hawai'i. The data collection period was eight and a half months. Data was interpreted based on constant comparative analysis in order to identify most generative patterns in the field notes. RESULTS: Group structures appear to play a significant role regarding the activity of the group members. In this study, we identified four key factors that influence group based physical activity: 1) Physical activity seems to be a group disturbing behaviour particularly in larger groups of adults; 2) Physical activity appears to be more functional and less joyful in adults than in children; 3) Group activity is influenced by (in)activity anchors, including 'domestication' of a group's site, obesity, and controlling parents. 4) Physical activity is to a certain extent socially contagious, particularly with regard to playful activities. CONCLUSIONS: Successful promotion of physical activity should target the social structures of inactive individuals' groups. In this regard, one of the main problems is that fun and wellbeing, as very important targets of public health strategies for the adult population, appear not to be compatible with physical activity. Developing strategies to reframe physical activity rather as 'fun' and less as functional may be one way to engage inactive individuals in physical activity in leisure settings.

Belonging as a force of agency : an exploration of immigrant children’s everyday life in early childhood settings

The notion of agency is being used with increasing frequency in early childhood policies, replacing traditional assumptions about young children’s immaturity and their role as mere recipients of adults’ arrangements. Agency is thus both an educational aspiration as well as a signifier of a strong rights-based political commitment to countering views of children as immature and incompetent. This article develops the argument that agency is inherently a sociocultural product that is driven by children’s clear attempts to bond with others and to develop a sense of belonging. Using examples of the everyday experiences of two Chinese immigrant children in an early childhood centre, the article considers ways in which agency was exercised by the children in an unfamiliar sociocultural setting because they wanted to belong. Some crucial issues are highlighted for practice and policy development in the area of immigrant children’s education, arguing that the shaping of early childhood education requires an attention to children’s ‘invisible’ capabilities, needs to belong and ‘small’ everyday life realities.

Covert dose reduction is a distinct type of medication non-adherence observed across all care settings in inflammatory bowel disease.

BACKGROUND: Non-adherence by dose omission is common and deleterious to outcomes in Inflammatory Bowel Disease (IBD), but covert dose reduction (CDR) remains unexplored. AIMS: To determine frequency and attitudinal predictors of overall medication non-adherence and of covert dose reduction as separate entities. METHODS: A cross sectional questionnaire was undertaken involving IBD patients in three different geographical regions and care settings. Demographics, medication adherence by dose omission, and rate of patient initiated dose reduction of conventional meds without practitioner knowledge (CDR) were assessed, along with attitudes toward IBD medication. RESULTS: Of 473 respondents (mean age 50.3 years, 60.2% female) frequency of non-adherence was 21.9%, and CDR 26.9% (p<0.001). By logistic regression, significant independent predictors of non-adherence were dissatisfaction with the patient-doctor relationship (p<0.001), depression (p=0.001), anxiety (p=0.047), and negative views regarding medication efficacy (p<0.001) or safety (p=0.017). Independent predictors of covert dose reduction included regular complementary medicine (CAM) use (p<0.001), experiencing more informative (p<0.001) and comfortable (p=0.006) consultations with alternative practitioners, disbelieving doctor delivered information (p=0.021) and safety concerns regarding conventional medication (p<0.001). Neither the frequency of non-adherence (p=0.569) nor CDR (p=0.914) differed between cohorts by different treatment settings. CONCLUSIONS: Covert dose reduction of IBD medication is more common than omission of medication doses, predicted by different factors to usual non-adherence, and has not been previously reported in IBD. The strongest predictor of CDR is regular CAM use.

The role of play in teaching English as foreign language in early childhood settings in Indonesia.

This research highlights a teacher’s transformative thinking which has profound implications on how teachers conceptualise child play and learning, thus leads to a way of thinking about English as a foreign language (EFL) could better be supported through the use of play-based pedagogies, especially dramatic play in Indonesian context.