The effects of time pressure and experience on nurses' risk assessment decisions : a signal detection analysis

Background: Time pressure and, occasionally, suboptimal assessment decisions are features of nursing in acute care.

Objectives: To explore the effect of generic and specialist clinical experience on the ability to detect the need to take action in acute care and the impact of time pressure on nurses' decision-making performance.

Methods: Experienced acute care registered nurses (n = 241) were presented with 50 vignettes of real clinical risk assessments. Each vignette contained seven information cues. In response to these vignettes, nurses had to decide whether to intervene or not. The 26 vignettes were time limited and mixed randomly into the 50 cases. Signal detection analysis was used to establish nurses' performance, personal decision thresholds ([beta]), and their abilities (d') to distinguish a signal of clinical risk from the clinical noise of noncontributory information.

Results: Nurses had significantly lower d' and were significantly less likely to indicate intervening under time pressure. For ability-but not threshold-there was a significant interaction of time pressure and years of experience in acute care. With no time pressure, d' increased in line with years of experience. Under time pressure, there was no effect.

Discussion: Time pressure reduced nurses' ability to detect the need and the tendency to report intervening. Thus, there were more failures to report appropriate intervention under time pressure, and the positive effects of clinical experience were negated under time pressure. More and larger scale research on the effect on clinical outcomes of time pressured nursing choices is required.

Providing real-time information services for public bus commuters

This paper investigates RTIS for public bus commuters; identifying their needs and proposing the architecture and design for this service. Considering that the service needs to be extensible, adaptable and interoperative, the new system is based on the use of XML Web Services. This gives the structure flexibility for further development and integration with other like services.

Learning in virtual teams: exploring the student experience

In 2005 an existing undergraduate course in project management was converted from face-to-face mode to wholly online mode. Wholly online mode means that there are no face-to-face classes at all, and all teaching and learning is facilitated through an online environment.

The revised project management course was designed with an underlying problem-based learning (PBL) pedagogy and used a simulated, fictitious telecommunications company, United Enterprises (UE), as a case study learning resource. The students worked in virtual teams to complete online learning activities and to solve authentic project management tasks for UE. Employees of UE were available online to provide direction and answer further questions about the tasks.

The overall research study used an action research methodology in which feedback was elicited from two groups of stakeholders involved in the project management course - students and teaching staff. The feedback was used to plan, develop and implement the new Information Technology (IT) Professional Practice course.

This paper reports on the findings of three anonymous student surveys that were conducted after each of the main project management topics and tasks were completed. The surveys sought feedback in a number of areas. However, the feedback reported here relates specifically to student opinions about their experiences of working in virtual teams within the learning environment. Other aspects of the research, including student perceptions of UE and feedback from the teaching staff, are not reported here.

Across the three surveys, most students indicated that they valued the opportunity to discuss various aspects of the course with peers and teaching staff online, and to interact with real-life employees of UE. Although discussion forums were the prescribed method for communication other forms of communication such as email, chat and face-to-face meetings were also used. According to the students, the best things about online group work were that it provides the flexibility of time and place; it allows communication and participation to be recorded; and is an ‘efficient’ way of working. The worst things about online group work were that communication is more difficult and that team members leave participation and submission to
the last minute. While up to 15 percent of students did not like the experience of online group work at all, overall students were generally satisfied with this style of learning and enjoyed the experience of working collaboratively within a virtual team.

The research has highlighted a number of areas where improvements can be made to the student experience of working in virtual teams. These improvements will be adopted in the development and delivery of the new course as part of the action research study.

End-user experience with information in Web-based electronic service : a case study

End-user experience with information presumably considered as one of the prominent factors shaping the adoption of web-based electronic services. User interfacing with large amount of information the rationale is to deduce the effect in the current web-based task environment. Understanding user’s perception on the basis of the prior experience with information may provide insights into what constitutes in driving those perceptions and their effect in the current and future task in web-based electronic services. The paper lays the theoretical context of end-user experience with information and proceeds further in an attempt to distinguish the role in web-based electronic services.

Quality-of-life measurement in patients undergoing radiation therapy for head and neck cancer: a Hong Kong experience

The aims of this study are (1) to establish a reliable and valid quality-of-life (QOL) questionnaire for Chinese patients with head and neck (H&N) cancer who are treated with radiation therapy and (2) to evaluate the impact of the immediate side effects of treatment on the QOL of these patients. The 39-item "Quality of Life Radiation Therapy Instrument with Head and Neck Companion Module" (QOL-RTI/H&N) was translated into Chinese. In the reliability evaluation phase (study module 1), the questionnaire was administered twice to 56 H&N cancer patients, 7 days apart, during the second and third week of radiation therapy. In the validity evaluation phase (study module 2), 138 patients completed the QOL-RTI/H&N before starting and at the end of radiation therapy. Sixty-nine of these 138 patients also completed the QOL-RTI/H&N during the second week of their radiation therapy, at the same time as completing the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) questionnaire. Cronbach alpha coefficients were 0.88 for the general-tool QOL-RTI and 0.90 for the H&N subscale. Test-retest reliability was satisfactory with intraclass correlation coefficients of 0.89 for the general-tool QOL-RTI and 0.75 for the H&N subscale. The instrument can discriminate between patients with stage I or II disease and those with stage III or IV disease (P < .05). Concurrent validity was established by the good agreement with the FACT-H&N (r = 0.86, P < .001). A highly significant deterioration was in the QOL from the baseline to the end of treatment (mean difference for general tool = 1.95, P < .001; mean difference for H&N subscale = 4.85, P < .001). The Chinese QOL-RTI/H&N is a reliable and valid tool for determining the QOL in H&N cancer patients receiving radiation therapy. The immediate side effects of treatment had a significantly negative impact on the patients' QOL. The impact was relatively large for the functional and treatment-site aspects.

Exploring general practitioners' experience of informing women about prenetal screening tests for foetal abnomalities : a qualitative focus group study

Background: Recent developments have made screening tests for foetal abnormalities available earlier in pregnancy and women have a range of testing options accessible to them. It is now recommended that all women, regardless of their age, are provided with information on prenatal screening tests. General Practitioners (GPs) are often the first health professionals a woman consults in pregnancy. As such, GPs are well positioned to inform women of the increasing range of prenatal screening tests available. The aim of this study was to explore GPs experience of informing women of prenatal genetic screening tests for foetal abnormality.
Methods: A qualitative study consisting of four focus groups was conducted in metropolitan and rural Victoria, Australia. A discussion guide was used and the audio-taped transcripts were independently coded
by two researchers using thematic analysis. Multiple coders and analysts and informant feedback were employed to reduce the potential for researcher bias and increase the validity of the findings.
Results: Six themes were identified and classified as 'intrinsic' if they occurred within the context of the consultation or 'extrinsic' if they consisted of elements that impacted on the GP beyond the scope of the
consultation. The three intrinsic themes were the way GPs explained the limitations of screening, the extent to which GPs provided information selectively and the time pressures at play. The three extrinsic
factors were GPs' attitudes and values towards screening, the conflict they experienced in offering screening information and the sense of powerlessness within the screening test process and the health
care system generally. Extrinsic themes reveal GPs' attitudes and values to screening and to disability, as well as raising questions about the fundamental premise of testing.
Conclusion: The increasing availability and utilisation of screening tests, in particular first trimester tests,has expanded GPs' role in facilitating women's informed decision-making. Recognition of the importance
of providing this complex information warrants longer consultations to respond to the time pressures that GPs experience. Understanding the intrinsic and extrinsic factors that impact on GPs may serve to shape
educational resources to be more appropriate, relevant and supportive.

Validity and reliability of measures of television viewing time and other non-occupational sedentary behaviour of adults : a review

Time spent in non-occupational sedentary behaviours (particularly television viewing time) is associated with excess adiposity and an increased risk of metabolic disorders among adults; however, there are no reviews of the validity and reliability of assessing these behaviours. This paper aims to document measures used to assess adults' time spent in leisure-time sedentary behaviours and to review the evidence on their reliability and validity. Medline, CINAHL and Psych INFO databases and reference lists from published papers were searched to identify studies in which leisure-time sedentary behaviours had been measured in adults. Sixty papers reporting measurement of at least one type of leisure-time sedentary behaviour were identified. Television viewing time was the most commonly measured sedentary behaviour. The main method of data collection was by questionnaire. Nine studies examined reliability and three examined validity for the questionnaire method of data collection. Test–retest reliabilities were predominantly moderate to high, but the validity studies reported large differences in correlations of self-completion questionnaire data with the various referent measures used. To strengthen future epidemiological and health behaviour studies, the development of reliable and valid self-report instruments that cover the full range of leisure-time sedentary behaviour is a priority.

The valuation of fast-food outlets : analysis, methodology, and reliability

Fast-food outlets are a significant subsector of the hospitality and tourism property market in Australia, and have experienced significant growth and global change in the past 20 years. However, little attention has been given in professional and academic literature to the valuation methodology and analysis of these properties. This article proposes a working definition of a fast-food outlet, traces recent changes in the structure of the fast-food industry, investigates the major determinants of value with respect to asset value, and examines to what extent these have changed. In particular, it isolates the role of goodwill in assessing going-concern value.

The valuation of fast food outlets in Australia : methodology, analysis and reliability

Fast food outlets are a significant sub sector of the Hospitality and Tourism Property Market and a specialized form of business. This form of hospitality outlet has experienced significant growth and change in the last 20 years. Their value as an asset is therefore of significant interest to many involved in the tourism and hospitality industry, not least fast food operators or potential operators and their financiers. However, little attention has been given in professional and academic literature to valuation methodology, the analysis of the major components of asset value, and the underlying factors which influence asset value. As such the reliability of the valuation process could justifiably be questioned.
This paper sets out a working definition of a fast food outlet. It investigates the major determinants of value with respect to asset value and examines the accepted methods of valuation of fast food outlets in Australia as well as establishing the methods most commonly used. It clarifies the major components of asset value and examines to what extent these have changed with the changing business environment. In particular it isolates the role of Goodwill in assessing Going Concern Value. Sources of data include a comprehensive literature review and personal interviews with professionals involved in the valuation process. The paper concludes that an efficient valuation process requires that fast food outlets be considered as both a real estate and business investment. The contribution of both tangible and intangible assets to the value of the asset must be identified.

Phenomenological inquiry into the experience of web project managers

The advent of the Internet and the World Wide Web has been instrumental in bringing about the growth in the implementation of web-based information systems (WBIS). Such systems are designed with the aim of improving productivity, data accuracy, and the reduction of paperwork and administrative overheads. Moreover, unlike their conventional non-web-based predecessors, the WBIS are commonly aimed at users who are casual and untrained, geographically distributed and non-homogenous. The dissemination of WBIS necessitates additional infrastructure support in the form of a security system, workflow and transaction management, and web administration. WBIS are commonly developed using an evolutionary approach, whereby the version of the application, acquired from the vendor, is first deployed as a pilot, in order to gather feedback from the target users before the evolutionary cycles commence. While a number of web development methodologies have been proposed by existing research, there is a dearth of empirical evidence that elucidates the experiences of project initiators in pursuing the evolution of web services, a process that undoubtedly involves dealing with stakeholder issues. This research project presents a phenomenological investigation of the experiences of project managers with the implementation of web-based employee service systems (ESS), a domain that has witnessed a sharp growth in Australia in recent times. However, the project managers’ rich, multidimensional account of their experiences with the implementation of ESS revealed the social obstacles and fragility of intra-organizational relationships that demanded a cautious and tactful approach. Thus, the study provides a socio-organizational perspective to web projects in contrast to the functionalist paradigm of current web development methodologies. The research also confirms that consideration of the concerns of stakeholders by project managers is crucial to the successive cycles of ESS evolution. Project managers address stakeholder concerns by pursuing actions that are aimed at encouraging ESS usage, but at the same time, such actions can have consequences necessitating subsequent iterations of system enhancement and improvement. Finally, the research also discovered that despite the different socio-political climate prevalent in various organizations, in which ESS are being implemented, the experiences of project managers in dealing with stakeholder concerns can be captured and independently confirmed in terms of their perceived relevance and usefulness in problem-solving within the application domain.

Information-based regulation of high-velocity foot-targeting tasks

Judging time-to-contact with a target is an important criterion for avoiding harm in everyday walking and running tasks, and maximizing performance in high-velocity sporting tasks. The information-based regulation of step length and duration during target-directed locomotion was examined in relation to gait mode, approach velocity, target task, expertise, and sporting performance during a series of four experiments. The first three experiments examined novice performers (Each n=12, 6 males, 6 females), whilst the last experiment examined expert gymnasts (n=5). Two reference strips with alternating 50cm black and white intervals were placed on either side of the approach strip for all of the experiments. One 50Hz-panning video camera filmed the approach from an elevated position. In Experiment 4, two stationary 250Hz cameras filmed the post-flight performance of the gymnastic vaults and, in addition, two qualified judges provided a performance score for each vaulting trial. The panning video footage in each experiment was digitized to deduce the gait characteristics. In Experiment 4, the high-speed video footage was analyzed three-dimensionally to obtain the performance measures such as post-flight height. The utilization of visual stimulus in target-directed locomotion is affected by the observer's state of motion as characterized by the mode of locomotion and also often the speed of locomotion. In addition, experience plays an important role in the capacity of the observer to utilize visual stimulus to control the muscular action of locomotion when either maintaining or adjusting the step mechanics. The characteristics of the terrain and the target also affect the observer's movement. Visual regulation of step length decreases at higher approach speeds in novice performers, where as expert performers are capable of increasing visual regulation at higher approach speeds. Conservatism in final foot placement by female participants accounts for the observed increase in distance from the critical boundary of the obstacle relative to toe placement. Behavioural effects of gender thus affect the control of final foot placement in obstacle-directed locomotion. The visual control of braking in target-directed locomotion is described by a tau-dot of-0.54. When tau-dot is below -0.54 a hard collision with the obstacle will occur, however, when tau-dot is above -0.54, a soft collision with the target will occur. It is suggested that the tau-dot margin defining the control of braking reveals the braking capacity of the system. In the target-directed locomotion examined a tau-dot greater than -0.70 would possibly exceed the braking capacity of the system, thus, leading to injury if performed. The approach towards the take-off board and vaulting horse in gymnastics is an example of target-directed locomotion in sport. Increased visual regulation of the timing and length of each step is a requirement for a fast running approach, a fundamental building block for the execution of complex vaults in gymnastics. The successful performance of complex vaults in gymnastics leads towards a higher judge's score. Future research suggestions include an investigation of visual regulation of step length in curved target-directed locomotion.

Pocket books of engagement : a 'just-in- time' framework for a high quality first year student experience

This paper describes a 'just-in-time' engagement framework for a high quality first year experience ('FYE'). The concept 'just-in-time' refers to a student-centered timeline for a managed learning environment based on the week-to-week experiences faced by a first year student in an Australian University semester. The engagement framework detailed in this paper consists of a series of teaching strategies embedded as part of a designed, integrated and co-ordinated first year program, expanding on the transition blueprint of Nelson, Kift, Humphreys & Harper (2006), working within a transition pedagogy (Kift, 2008) and implementing an institutional-wide program of collaborative engagement. This paper discusses the application of this framework to a first year foundational unit in the Bachelor of Laws degree at Deakin University, Victoria, Australia, implemented as part of an embedded institutional-wide transition program.

Determinants of time-to-contact judgements

The experiments reported in this thesis investigated the visual information used by observers to judge the time-to-contact (TTC) of approaching objects. The results provide support for the proposition that TTC judgements are based on retinal image expansion rate and observers' prior experience with the objects.

Can you teach all of the people some of the time? The development and evaluation of information literacy programs at the University of Queensland Library

Information skills and computer literacy are now seen by many within the academic community as essential. They are key graduate attributes required by students for lifelong learning and leadership roles in business and industry, government and society. Trends in the higher education sector bringing a renewed focus to teaching and preparing students for a global knowledge economy are outlined.

This paper focuses upon the power of a teaching and learning policy framework which supports the integration of information literacy into the curriculum. The increasing ease with which collaborative partnerships are formed between academic planners, course coordinators and librarians is highlighted by case studies of successful programs. Challenges are identified and change strategies described.

Potential applications of discrete-event simulation and fuzzy rule-based systems to structural reliability and availability

This chapter discusses and illustrates some potential applications of discrete-event simulation (DES) techniques in structural reliability and availability analysis, emphasizing the convenience of using probabilistic approaches in modern building and civil engineering practices. After reviewing existing literature on the topic, some advantages of probabilistic techniques over analytical ones are highlighted. Then, we introduce a general framework for performing structural reliability and availability analysis through DES. Our methodology proposes the use of statistical distributions and techniques – such as survival analysis – to model component-level reliability. Then, using failure- and repair-time distributions and information about the structural logical topology (which allows determination of the structural state from their components’ state), structural reliability, and availability information can be inferred. Two numerical examples illustrate some potential applications of the proposed methodology to achieving more reliable and structural designs. Finally, an alternative approach to model uncertainty at component level is also introduced as ongoing work. This new approach is based on the use of fuzzy rule-based systems and it allows the introduction of experts’ opinions and evaluations in our methodology.