Critical incident analyses : a practice learning tool for students and practitioners

The development of critical skills in social work students and practitioners has been a major focus of social work education and training in recent years. Critical incident analysis has developed as a tool to aid critical reflection in practice, in health and social work. This paper provides an overview of the use of the tool in these fields. It then reports on a demonstration project which sought to examine how critical incident analysis might be used as a form of assessment and as a supervisory tool by social work students and practice teachers. An evaluation of the project is provided. Completion of critical incident analyses using the framework was found to provide a structured approach to critical reflection. It assisted the integration of theory and practice and the examination of value issues. Students and practice teachers identify its use in supervision and its potential as an assessment tool. The paper concludes with a discussion on the potential uses of critical incident analyses, with particular attention given to its use to develop anti-oppressive practice.

Reflexive capability maturity assessment for firm management of multipartner international projects

This paper reports the findings of a research project which was aimed at developing and promoting a greater understanding of the uniqueness of successful Australian-Malaysian partnerships and joint ventures undertaken on complex multi-partner mega construction projects. The aim of the investigation was to identify the critical success factors specific to such partnerships. The theoretical framework was grounded in a previous empirical study on design firm internationalisation which demonstrated that long-term success in international markets is enhanced by the management of integration of transformation of social, cultural and intellectual capital within the firm. A generic adaptive performance framework mapping the key performance indicators for each of these dimensions was developed which can be modified to unique contexts related to specific geographical localities. In the Australian Malaysian Institute study the framework is tested within the context of firm and shared partnership capital. The broad interpretive framework of adaptive performance was refined as a result of the findings of the four case studies of Malaysian organisations to develop a partnerships capacity performance measurement framework for Malaysian firms working on international projects. Six in-depth interviews were conducted with ten participants across the four Malaysian firms and a thematic analysis was undertaken of the transcripts. A reflexive capability maturity assessment tool was developed from insights gained into the underlying causes of key barriers coupled with common themes emerging in relation to the successful approaches used by case study firms to overcome those barriers. Specific examples of the case study firms' demonstration of reflexive capability in the areas of market knowledge, design management and market entry are presented.

Biological maturity and primary school children's physical activity : influence of different physical activity assessment instruments

Biological maturation may attenuate hypothesized sex differences in children’s physical activity but overall the evidence for this is equivocal. In this study, we investigated how the selection of different physical activity assessment instruments affects the detected relationship between biological maturation and late primary school children’s physical activity. Altogether, 175 children (97 girls, 78 boys) aged 10.690.3 years completed the PAQ-C self-report questionnaire and wore ActiGraph GT1M accelerometers for 5 consecutive days. Maturity status was predicted by estimating attainment of age at peak height velocity. Following initial exploration of sex differences in PAQ-C (t-test) and multiple ActiGraph outcome variables (MANOVA), the influence of maturity status was controlled using ANCOVA and MANCOVA. Unadjusted analyses revealed that boys were significantly more active than girls according to the PAQ-C (PB0.0001, d0.52) and ActiGraph (PB0.0001, d0.360.72). After controlling for maturity status, the differences in PAQ-C scores increased (P0.001, d0.64), but the significant differences disappeared for the ActiGraph data (P0.36, d0.170.33). The detected relationship between maturity status and late primary school children’s physical activity is dependent on the physical activity assessment tool employed, reflecting the different aspects of physical activity captured by the respective measures.

Development and validation of the Diet Quality Tool for use in cardiovascular disease prevention settings

The aim of this study was to develop and evaluate a dietary screening tool for use in a secondary cardiovascular disease (CVD) prevention setting to identify an individual’s overall dietary quality. The Diet Quality Tool (DQT) was validated against a 4-day food diary for 37 individuals with established CVD attending cardiac rehabilitation. Construct validity was demonstrated for % energy from saturated fat (P = 0.002, r = –0.500), dietary fibre (P < 0.001, r = 0.559) and omega-3 fatty acids (P = 0.048, r = 0.327). Criterion validity was established with a significant difference found between mean (95% CI) dietary intakes of fibre (28.2 g, 4.4 to 17.3) and % total energy from saturated fat (10.6%, –4.8 to –0.8) for those with better DQT scores (>60%) versus those with poorer scores (≤60%) when compared with 4-day food diary nutrient values. The usefulness of the DQT was confirmed by both patients (n = 25) and cardiac rehabilitation health professionals (n = 8). The DQT was found to be a valid and useful dietary assessment tool with potential for use in a secondary CVD prevention setting. The tool has the capacity to be used in a wider variety of settings and further refinement of the tool would enable a greater amount of nutrients to be reliably screened.

Client self-assessment in community aged care: A comparative study involving older Australians and their case managers

Self-assessment of support needs is a relatively new and under-researched phenomenon in domiciliary aged care. This article outlines the results of a comparative study focusing on whether a self-assessment approach assists clients to identify support needs and the degree to which self-assessed needs differ from an assessment conducted by community care professionals. A total of 48 older people and their case managers completed a needs assessment tool. Twenty-two semi-structured interviews were used to ascertain older people’s views and preferences regarding the self-assessment process. The study suggests that while a co-assessment approach as outlined in this article has the potential to assist older people to gain a better understanding of their care needs as well as the assessment process and its ramifications, client self-assessment should be seen as part of a co-assessment process involving care professionals. Such a co-assessment process allows older people to gain a better understanding of their support needs and the wider community aged care context. The article suggests that a co-assessment process involving both clients and care professionals contains features that have the capacity to enhance domiciliary aged care.

Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis

Introduction: While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the Post-Anaesthetic Care Unit. These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether use of PACT will i) enhance the recognition and response to patients at risk of deterioration in PACU; ii) improve documentation for handover from PACU nurse to ward nurse; iii) result in improved patient outcomes; and iv) reduce health care costs.

Methods and analysis: A prospective, non-randomised, pre- and post-implementation design comparing: (i) patients (n=750) who have surgery prior to the implementation of the PACT and (ii) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre- and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as odds ratios with the corresponding 95% confidence intervals.

Conclusion: This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce health care costs.

Evaluation of AUSDRISK as a screening tool for lifestyle modification programs: international implications for policy and cost-effectiveness

OBJECTIVE: To evaluate the current use of Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) as a screening tool to identify individuals at high risk of developing type 2 diabetes for entry into lifestyle modification programs.

RESEARCH DESIGN AND METHODS: AUSDRISK scores were calculated from participants aged 40-74 years in the Greater Green Triangle Risk Factor Study, a cross-sectional population survey in 3 regions of Southwest Victoria, Australia, 2004-2006. Biomedical profiles of AUSDRISK risk categories were determined along with estimates of the Victorian population included at various cut-off scores. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and receiver operating characteristics were calculated for AUSDRISK in determining fasting plasma glucose (FPG) ≥6.1 mmol/L.

RESULTS: Increasing AUSDRISK scores were associated with an increase in weight, body mass index, FPG, and metabolic syndrome. Increasing the minimum cut-off score also increased the proportion of individuals who were obese and centrally obese, had impaired fasting glucose (IFG) and metabolic syndrome. An AUSDRISK score of ≥12 was estimated to include 39.5% of the Victorian population aged 40-74 (916 000), while a score of ≥20 would include only 5.2% of the same population (120 000). At AUSDRISK≥20, the PPV for detecting FPG≥6.1 mmol/L was 28.4%.

CONCLUSIONS: AUSDRISK is powered to predict those with IFG and undiagnosed type 2 diabetes, but its effectiveness as the sole determinant for entry into a lifestyle modification program is questionable given the large proportion of the population screened-in using the current minimum cut-off of ≥12. AUSDRISK should be used in conjunction with oral glucose tolerance testing, fasting glucose, or glycated hemoglobin to identify those individuals at highest risk of progression to type 2 diabetes, who should be the primary targets for lifestyle modification.

Assessment of human kinematic performance with non-contact measurements for tele-rehabilitation

 Aging of population is challenging the traditional rehabilitation services for various movement disorders. In the foreseeable future, tele-rehabilitation will be a contributive factor for the well-being of the older generation. This research has tackled a series of problems in developing an automated assessment tool for human kinematic performance in tele-rehabilitation with optoelectronic bio-kinematic motion capture devices and preliminarily confirmed its applicability.

Teachers’ perceptions of a fundamental movement skill assessment battery in a school setting

Fundamental movement skills (FMS) competence is low in adolescent girls. An assessment tool for teachers is needed to monitor FMS in this demographic. The present study explored whether the Canadian Agility and Movement Skill Assessment (CAMSA) is feasible for use by physical education (PE) teachers of Australian Year 7 girls in a school setting. Surveys, focus group interviews, and direct observation of 18 specialist PE teachers investigated teachers’ perceptions of this tool. Results indicated that the CAMSA was usable in a real-world school setting and was considered a promising means to assess FMS in Year 7 girls. However, future iterations may require minor logistical alterations and further training for teachers on how to utilize the assessment data to enhance teaching practice. These considerations could be used to improve future design, application, and training of the CAMSA in school-based PE.

Assessment of simulated clinical skills and distance students: can we do it better?

Australian universities have traditionally been able to supplement clinical education, for undergraduate nursing courses, delivered on placement with weekly clinical teaching in the simulated environment. The Objective Structured Clinical Assessment (OSCA) tool has been used in this simulated environment to assess clinical skills. Recently, however, online delivery of undergraduate nursing courses has become more common. The move from an internal mode of teaching to an online external mode is seen worldwide and poses challenges to staff and students as well as changing the teaching and learning culture of institutions (Philip and Wozniak, 2009). This cultural shift and the resulting diminishing timeframe for students to acquire and practice simulated clinical skills imply that it may become necessary to rethink assessment forms such as the OSCA assessment. This study examines whether or not the OSCA tool developed by Bujack et al. (1991a) is the best tool to be used in this new context, where online teaching is supplemented by very short, annual, intensive periods of study. Skills acquisition theories dictate that time is required to produce an ideal skills acquisition environment (Quinn, 2000) but the time constraints placed on students in such intensive periods of study could influence skills acquisition. This cross-sectional qualitative study used semi-structured interviews and focus groups to collect data. 65% of the nursing faculty participated in the study. The teaching of the Bachelor of Nursing (BN) occurred on two campuses and staff from both areas participated. This group of nurse academics was employed across the range of academic levels (from lecturer to professor) at the University. Data analysis followed a generic thematic analysis framework. Findings in this study show that there are a variety of attitudes and underpinning beliefs amongst staff in relation to the OSCAs. Doubts were raised in regard to the suitability of the use of the OSCA tool in this setting. It also became apparent during this study that the OSCA tool possibly serves purposes other than an assessment tool.

Nurse academics perceptions of the efficacy of the OSCA tool

The use of Objective Structured Clinical Examination/Objective Structured Clinical Assessment (OSCE/OSCA) has been well documented. How assessors currently view the process, and if the OSCA tool still fulfils the assessment requirements, is unclear. In this study, the beliefs and expectations of assessors towards the assessment tool used in an undergraduate nursing degree to assess clinical skills was investigated. A cross-sectional study used semi-structured interviews and focus groups with 16 lecturers in nursing from a rural Australian university. This represents 65% of the total nurse academic staff employed there. The key issues that the academic staff raised reflect those from previous studies, such as the use of OSCA as formative assessment or a quality check process before the clinical practice. The OSCAs were seen as a good assessment tool, which gave students the opportunity to receive feedback on their performance in relation to clinical skills. The drawbacks identified in relation to the use of OSCAs were that the OSCA was seen as stressful to students. This drawback was thought to be further compounded if there was a lack of congruence regarding essential criteria between assessors. If not adequately addressed these drawbacks will erode the potential the OSCA tool has to foster uniformity, which was one of the main reasons for its implementation. .

Evaluation of three daily rainfall generation models for SWAT

The Soil and Water Assessment Tool (SWAT) is a hydrologic model that was developed to predict the long-term impacts of land use change on the water balance of large catchments. Stochastic models are used to generate the daily rainfall sequences needed to conduct long-term, continuous simulations with SWAT. The objective of this study was to evaluate the performances of three daily rainfall generation models. The models evaluated were the modified Daily and Monthly Mixed (DMMm) model, skewed normal distribution (SKWD) model and modified exponential distribution (EXPD) model. The study area was the Woady Yaloak River catchment (306 km2) located in southwest Victoria, Australia. The models were assessed on their ability to preserve annual, monthly and daily statistical characteristics of the historical rainfall and runoff. The mean annual, monthly, and daily rainfall was preserved satisfactorily by the models. The DMMm model reproduced the standard deviation of annual and monthly rainfall better than the SKWD and EXPD models. Overall, the DMMm model performed marginally better than the SKWD model at reproducing the statistical characteristics of the historical rainfall record at the various time scales. The performance of the EXPD model was found to be inferior to the performances of the DMMm and SKWD models. The models reproduced the mean annual, monthly, and daily runoff relatively well, although the DMMm and SKWD models were found to preserve these statistics marginally better than the EXPD model. None of the models managed to reproduce the standard deviation of annual, monthly, and daily runoff adequately.

Pressure injury: an exploration of the relationship between risk factors and interface pressure

Pressure injuries are a serious risk for patients admitted to hospital and are thought to result from a number of forces operating on skin tissue (pressure, shear and friction). Most research on interface pressure (IP) has taken place using healthy volunteers or mannequins. Little is currently known about the relationship between pressure injury risk and IP for hospital patients. This relationship was investigated with a sample of 121 adult hospital patients. Pressure injury risk was evaluated using the Waterlow Risk Assessment Tool (WRAT) and IP was measured at the sacrum using a Tekscan ClinSeatTM IP sensor mat. Other factors considered were body mass index (BMI), blood pressure, reason for hospital admission, comorbidities and admission route to hospital. Patients were classified according to WRAT categories (‘low risk’, ‘at risk’, ‘high risk’, ‘very high risk’) and then remained still on a standard hospital mattress for 10 minutes while IP was measured. Participants in the ‘low risk’ group were significantly younger than all other groups (p<0.001) and there were some group differences in BMI. IP readings were compared between the ‘low risk’ group and all of the participants at greater risk. The ‘low risk’ group had significantly lower IP at the sacrum on a standard hospital mattress than those at greater risk (p=0.002). Those at greater risk tended to have IP readings at the low end of the compromised IP range. This study is significant because it describes a new, clinically relevant methodology and presents findings that challenge clinician assumptions about the relationships between pressure injury risk assessment and IP.

Revising the critical care family needs inventory for the emergency department

Background: The Critical Care Family Needs Inventory (CCFNI) has been used widely over the last two decades for analysing the needs of family members in the intensive care unit. However, it has significant limitations as a needs assessment tool for use with families in the Emergency Department (ED). This paper discusses the methodological challenges encountered during the process of reviewing and adapting this tool for use in the ED. Aims: The purpose of this study was to revise and adapt the CCFNI for use with a population of family members of critically ill patients in an Australian Emergency Department. Instrument: The process of tool revision, adaptation and reconstruction included: critique of the CCFNI; concept definition; item review; content and structure revision; scale revision; and testing with a sample of the target population. Methods: Data collection methods were aimed at accessing a vulnerable population, while enhancing response rate and data quality. A sample of 84 relatives of critically ill patients from one Melbourne Metropolitan Emergency Department was used, 73% of whom returned questionnaires. Results: Pilot data were examined with the specific purpose of identifying elements of the tool that required refinement or modification. Methods used for establishing reliability and validity of the revised tool provided satisfactory results. Limitations: Limitations of this study include inadequate sample size for exploratory factor analysis, and an incomplete response set for some items, which influenced item analysis. Conclusion: The process used for addressing the identified methodological issues in reviewing and adapting the CCFNI for use in the ED provides a framework for adapting an established tool for a specific purpose.