Emergency nurses' opinions regarding paediatric fever: the effect of an evidence-based education program

Introduction: The beliefs and opinions of individual nurses are key factors in clinical decisions. Emergency nurses’ clinical decisions related to paediatric fever establish emergency department norms, provide role-modelling for both peers and parents, underpin clinical management of febrile children, and influence fever management advice given to parents. Aim: This study aimed to examine: (i) the opinions of emergency nurses regarding paediatric fever, and (ii) the effect of an evidence-based education program on the opinions of emergency nurses regarding paediatric fever. Method: This study used a prospective pre-test/post-test design. The primary outcome measure was emergency nurses’ opinions measured using the ‘General Opinions about Fever Management in Children’ survey. The intervention for the study was two tutorials. Pre-test data was collected in June 2005 and post-test data was collected during August 2005. Results: Thirty-one emergency nurses participated in the study. There were a number of positive changes in emergency nurses’ opinions regarding paediatric fever as a function of an evidence-based educational intervention. Major domains of change were relationship between temperature and illness severity/risk of harm, use and effects of antipyretic medication and febrile convulsions.  Conclusion: Emergency nurses are an important source of information for parents leaving the emergency department with a febrile child. Opinions can be a major influence in nurses’ clinical decisions and many fever  management strategies used by health care professionals are reflective of individual beliefs rather than the best available evidence. The results of this study showed a number of positive changes in emergency nurses’ opinions regarding paediatric fever as a function of an evidence-based educational intervention.

Teacher attitudes and perceptions of primary school music education at independent schools in South Africa

As South Africa enters the new millennium and is currently in its second term of democracy, the question remains: is outcomes-based education preliminary the way forward for learners in South Africa. The new education system recognises the importance of arts education and specifically music education at the primary school level. This article focuses on music education at independent schools in Gauteng, South Africa. The reporting of this article is based on the author's doctoral thesis entitled "Outcomes-based music education in the foundation phase at independent schools in Gauteng, South Africa". The principal form of research was a questionnaire sent to music teachers at primary schools registered with the Independent Schools Council (ISC). The purpose of the questionnaires was to contribute to a study on teachers' perceptions, attitudes and opinions regarding music education and outcomes-based education. The questionnaire was divided into three main sections, namely: personal and professional details, outcomes-based education and general information. Both open and closed types of questions were employed. The questionnaire yielded both ambivalent views about the change of the education system as well as the inclusion of music as an area of learning within "Arts and Culture". It also identified current teaching trends and exposed areas of weakness that call for attention.

Operating a studio within a research culture: the urban heart surgery design research forum

The question of whether or not design can be considered research has perplexed schools of architecture ever since they were first introduced into universities. It was at the center of the Oxbridge union debates in the early 1900s. It formed one of the corner stones of the Oxford conference on education organized by the RIBA in 1958 (Martin 1958) and came under scrutiny again in the UK with the introduction of the Research Assessment Exercise (RAE) in 1992. While the arguments both for and against are considerable1, “in order to understand the questions and the possibilities of architectural research and to respond to the difficulties that confront us now, we have to have a model which acknowledges what schools of architecture really are, and could be, and then work with that” 2.
Drawing on professionally oriented research models, such as qualitative ‘clinical research’, from Medicine and the Health Sciences - where the processes of exploration, observation, investigation, recording and communication are conducted in-situ by the ‘practitioner-as-researcher’ 3 - the following paper outlines an initiative introduced in 1999, referred to as the ‘Urban Heart Surgery’ 4. The program actively integrates students entering their second degree program into a studio based design research culture and allows them to engage in critical discourse by working on high profile strategic design projects in three areas significant to Victoria’s future growth: Metropolitan Urbanism, Urbanism on the Periphery, and Regional Urbanism.
With a growing core of industrial and community based partnerships, including: four regional councils (Bendigo, Ballarat, Geelong and Warrnambool) and three metropolitan municipalities (Melbourne City, Port Phillip and Wyndham), the forum actively facilitates a graduate/practice research agenda through the ARC linkage grant program.

Engineering education down under : distance teaching at Deakin University, Australia

Deakin University in Australia is one of the leading providers of distance education in the South Pacific region. The School of Engineering offers four-year professional engineering-degree programs and three-year technologist programs. The over 600 total students studying engineering at Deakin fall into four categories:

• 18-19 year-old students fresh from high school, who largely study on-campus,
• older students in the technical workforce, seeking a university degree to upgrade their qualifications,
• industry-based students studying in university-industry partnership programs,
• overseas students studying either on-campus, or off-campus through education partners in Malaysia and Singapore.

Geographically these students form a very wide student base. The study programs are designed to produce multi-skilled, broadly focused engineers and technologists with multi-disciplinary technical competence, and the ability to take a systems approach to design and operational performance. A team of around 25 academic staff deliver courses in seven different majors in the general fields of manufacturing, environmental engineering, mechatronics, and computer systems. We discuss here the history of the School, its teaching philosophy, and its unique methods in delivering engineering education to a widely scattered student body.

The diversity of critical care nursing education in Australian universities

A range of critical care nursing educational courses exist throughout Australia. These courses vary in level of award, integration of clinical and academic competence and desired educational outcomes; this variability potentially leads to confuson by stakeholders regarding educational and clinical outcomes. The study objective was to describe the range of critical care nursing courses in Australia. Following institutional ethics approval, all relevant higher education providers (n=18) were invited to complete a questionnaire about course structure, content and nomenclature. Information about desired professional and general graduate characteristics and clinical competency was also sought.

A total of 89% of providers (n=16) responded to the questionnaire. There was little consistency in course structure in regard to the proportion of each programme devoted to core, speciality or generic subjects. In general, graduate certificate courses concentrated on core aspects of critical care, graduate diploma courses provided similar amounts of critical care core and speciality content, while master's level courses concentrated on generic nursing issues. The majority of courses had employment requirements, although only a small proportion specified the minimum level of critical care unit required for clinical experience. The competency standards developed by the Australian College of Critical Care Nurses (ACCCN) were used by 83% of providers, albeit in an adapted form, to assess competency. However, only 60% of programmes used personnel with a combined clinical and educational role to assess such competence.

In conclusion, stakeholders should not assume consistency in educational and clinical outcomes from critical care nursing education programmes, despite similar nomenclature or level of programme. However, consistency in the framework for speciality nurse education has the potential to prove beneficial for all stakeholders.

Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement

Aim. The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement.
Background. Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis.
Method. A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005.
Findings. Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study.
Conclusion. Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.

Music education and minority groups cultural and musical identities in the 'newer' South Africa : white Afrikaners and Indians

Music Education, as well as cultural and musical identities are all being renegotiated, post-Apartheid, within the so-called 'newer' rather than the commonly known 'new' South Africa. The developing situation with certain minority groups is particularly interesting. Education in general has undergone much change since the first democratic elections in 1994: music education specifically has been affected by such change in terms of content, delivery and assessment. Within the South African context, cultural and musical identities are often intertwined with language, racial and even tribal identities, and discussing one implies the others. We are particularly interested here in the role of formal Music Education in relation to white Afrikaners and Indians as they renegotiate their cultural development, including musical aspects

Barriers to effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

Australian gp's preferences for education about depression and related disorders

OBJECTIVE: To Investigate Australian general practitioners' experiences of accessing education about depression and their preferences for future education on depression and related disorders.
METHOD: Six hundred and eight anonymous surveys were distributed to GPs through 52 rural and urban divisions of general practice; 420 were retumed.
RESULTS: Educational formats involving direct contact with people having mental health expertise were highly valued. Distance education and web based technologies were least used. In the previous year, women and older GPs had spent more time on education about depression. Most intended to undertake more such education in the future and said that education in psychosocial strategies would be very useful. General practitioners' attitudes to further education about depression were influenced by their gender, practice location, and their previous mental health training.
DISCUSSION: More face-to-face training may be desirable to take advantage of GPs' willingness to spend more time on education about depression and related disorders.

Can Australain general practitioners tackle chidhood overweight/obesity? Methods and processes from the LEAP (live, eat, and play) randomized controlled trial

Background: General practitioners (GPs) could make an important contribution to management of childhood overweight. However, there are no efficacy data to support this, and the feasibility of this approach is unknown.

Objectives: To determine if GPs and families can be recruited to a randomized controlled trial (RCT), and if GPs can successfully deliver an intervention to families with overweight/obese 5- to 9-year-old children.

Methods: A convenience sample of 34 GPs from 29 family medical practices attended training sessions on management of childhood overweight. Practice staff trained in child anthropometry conducted a cross-sectional body mass index (BMI) survey of 5- to 9-year-old children attending these practices. The intervention focused on achievable goals in nutrition, physical activity and sedentary behaviour, and was delivered in four solution-focused behaviour change consultations over 12 weeks.

Results: General practitioners were recruited from across the sociodemographic spectrum. All attended at least two of the three education sessions and were retained throughout the trial. Practice staff weighed and measured 2112 children in the BMI survey, of whom 28% were overweight/obese (17.5% overweight, 10.5% obese), with children drawn from all sociodemographic quintiles. Of the eligible overweight/obese children, 163 (40%) were recruited and retained in the LEAP RCT; 96% of intervention families attended at least their first consultation.

Conclusions: Many families are willing to tackle childhood overweight with their GP. In addition, GPs and families can participate successfully in the careful trials that are needed to determine whether an individualized, family-based primary care approach is beneficial, harmful or ineffective.

Checks and cheques : implementing a population health and recall system to improve coverage of patients with diabetes in a rural general practice

Identification of all diabetic patients in the population is essential if diabetic care is to be effective in achieving the targets of the St Vincent Declaration.¹ The challenge therefore is to establish population based monitoring and control systems by means of state of the art technology in order to achieve quality assurance in the provision of care for patients with diabetes. ^2,3 Disease management receives extensive international support as the most appropriate approach to organising and delivering healthcare for chronic conditions like diabetes.⁴ This approach is achieved through a combination of guidelines for practice, patient education, consultations and follow up using a planned team approach and a strong focus on continuous quality improvement using information technology. ^5,6 The current software (Medical Director) could not easily meet these requirements which led us to adopt a trial of Ferret. In designing this project we used change management⁷ and the plan, do, study, act cycle⁸ illustrated in Diagram 1.

Changing universities, changing work : a consideration of diversity, change and the (re)organisation of work in higher education

This paper considers some of the issues relating to diversity for those working in Australian universities as teachers, managers and support staff. It considers the impacts of social, economic and technological change on the organisation of universities as sites of teaching, learning, supervision and research. The consequences of these changes on the ways universities are traditionally organised and operate is considered, and some of the major tensions which occur as a result are discussed. Examples in the areas of professional doctorates, new technology and libraries are explored briefly. Some suggestions are offered for reconceptualising the work of academic and general staff, as are the relationship between these changes in universities and those occurring in TAFE and VET.

Identifying the health and mental health information needs of people with coronary heart disease, with and without depression

Objective:
To identify the health and mental health information needs of people with coronary heart disease (CHD), with and without comorbid depression.

Design and setting:
A qualitative study conducted in Melbourne in 2006, using thematic analysis of semi-structured interviews on the types of health information that patients with CHD considered useful to assist with the management of their illness. Structured clinical interviews were used to assess current and prior depressive episodes in these patients.

Participants:
14 general practice patients (eight with current or prior history of major depression) who had experienced myocardial infarction, coronary artery bypass graft surgery, angioplasty or angina (confirmed via testing).

Results:
Four themes relating to information on how patients could manage their cardiovascular health and improve their psychosocial wellbeing emerged: psychosocial; physical activity; medical; and information for family. The most prominent information needs included identification and management of risk-related physical symptoms, and psychosocial information, most notably to enhance patients’ social support. Patients considered this information important for alleviating health anxiety and negative affect.

Conclusion:
This small patient sample endorsed the need for health and mental health information on a range of psychosocial and physical health topics. Participants desired specific types of information to assist with the self-management of their health and to assuage their health concerns.