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.

Loyalty program attributes and their influence on retail customer satisfaction

This paper empirically examines the extent to which loyalty program attributes explain variations in satisfaction with the retail offer. Two dimensions of loyalty program attributes are introduced including hard attributes and soft attributes. Store satisfaction is examined in terms of the elements of the retail offer. The results suggest that emphasis on hard and soft attributes enhance customer satisfaction with a retailers’ merchandise, trading format, customer service and customer communication. Additionally, hard attributes have a more significant influence than soft attributes on satisfaction with all elements of the retail offer excluding merchandise.

Allocative and informational pricing roles in MBA program choice

This paper reports on a study of how prospective and current MBA students (n = 699) made tradeoffs between tuition price and other variables in choosing a university program in the Australian market. Two price segments were identified: price-negative and price-positive. The price-positive segment constituted 13 per cent of the sample. The behaviour of the two price segments is interpreted in relation to the allocative and informational roles of price. Price-positive respondents were found to be more concerned with the reputational characteristics of universities and programs in making their choice. Age, enrolment mode, and residential state were found to be associated with segment membership. The results suggest that an MBA by distance education can be regarded as a prestige product for some market segments.

Leveraging the Commonwealth Games in Melbourne for community engagement: an examination of Equal First and the Adopt-a-Second-Team program

Event leverage provides information about what outcomes occur as a result of an event. Unlike event impact studies, event leverage analysis identifies why particular outcomes occurred, and the processes that can be used to optimise desired event outcomes. While research has been directed towards understanding how events can be leveraged to provide optimal economic outcomes for host communities, there is little research that examines social leverage within the context of events. The research presented in this paper is part of a larger study that investigated social leverage within the context of the 2006 Commonwealth Games, held in Melbourne, Australia. This paper presents preliminary results relating to two Victorian regions with regard to one the over-arching social policy, Equal First, and a subsidiary program called, Adopt-a-Second-Team. Participant observations and stakeholder interviews were employed to explore the development, operationalisation, implementation and outcomes of Equal First and Adopt-a-Second-Team. The results suggest that although each region achieved outcomes that were consistent with the directions of Equal First, each implemented the Adopt-a-Second-Team differently. The two case studies presented in this paper highlight that the model of implementation developed by the City of Port Phillip may provide a benchmark in social leverage of events. Implications for leveraging social impacts and managing social legacies of events through an approach that includes consideration of policy development and operationalisation from the event organising body and program implementation from the perspective of local community event organisers are discussed.

Program assessment and reporting: linking people, processes and data

As part of a larger Simplification Project for program quality assurance processes conducted at RMIT University, this paper chronicles the refinement of one aspect: program assessment and reporting. This involved the realignment of criteria used in program quality assurance with those developed in higher-level strategic and business planning processes. In addition, the project attempted to address the lack of alignment between annual program processes and subsequent decisions made about the future of programs, particularly in profile planning processes.
A revised Program Annual Report process was developed that aimed to achieve simplicity and alignment while re-engaging program leaders and heads of schools with the quality agenda. A concerted effort was made to develop a process that improved on previously poor vertical communication inherent in program quality assurance. This paper explores the ways in which this was achieved by a) linking people to data through the use of agreed and contextualised performance indicators, and b) linking people to process through more meaningful input into planning and opportunity for dialogue.

The Australian Government`s abandoned infrastructure outsourcing program: what can be learned?

Early in 2001, after a damning public report by the Auditor-General, the Australian Federal Government abandoned its highly promoted “whole of government” IT infrastructure outsourcing initiative. This about-face was greeted in the press with reports that the initiative was a “fiasco”. Yet a four-year case study conducted by the authors suggests a more complex picture. Like many other “selective” outsourcers of IT, the Federal Government had been led to believe that it was adopting a relatively low risk strategy that would, if well managed, lead to significant cost savings and operational benefits. Instead, despite having implemented many widely promoted “best practices”, the Federal Government found a substantial discrepancy between what outsourcing promised to deliver, and what was actually achieved. In this respect their experiences were no different from those of many other large IT organizations engaged in selective IT outsourcing, who responded to a substantial contemporaneous survey. This case study examines why the Government’s expectations were not achieved, and arrives at conclusions that have important implications for decision makers confronted with choices about sourcing IT service delivery.

Beyond satisfaction surveys: the development of an evaluation process for a postgraduate transferable skills program

Leadership, professional and other transferable skills are embedded in the expected attributes of Australian research postgraduates at the successful completion of their degrees. This paper reports on the development of an evaluation process for a postgraduate transferable skills program at The University of Melbourne, Australia. Existing and emerging evaluation practices and processes are examined in light of the literature on what constitutes 'good' evaluation of the type of program under consideration. The development of the process to go beyond the commonly used participant satisfaction surveys and to improve evaluation practices is described in detail. The results of the evaluation to date are provided and discussed in terms of their usefulness in incorporating particular improvements to the program. The implications for the evaluation of other programs of this type are considered.

Effects of a walking program in the psychiatric in-patient treatment setting: a cohort study.

Issue addressed: To assess the effectiveness of a walking program in a psychiatric in-patient unit. Method: In-patients at a private psychiatric unit were offered the opportunity to participate in a daily morning 40 minute walk led by an activity supervisor. After discharge, outcomes for patients who had regularly participated in the walking group (n=35) and patients who had not participated (n=49) were compared for length of stay during their period of admission and Clinical Global Impression - Severity (CGI-S) and  Depression Anxiety Stress Scales (DASS) scores measured at admission and discharge. This was a retrospective analysis of data collected routinely. Results: There were no significant differences between the two cohorts on most primary outcome measures, including length of stay, DASS scores at admission and at discharge and CGI-S scores at admission. Patients who had not participated in the walking group had a significantly lower score on a single measure, the CGI-S, than patients who had participated (p=0.001). Conclusions: This study showed no evidence that in-patients benefited from participating in the physical activity program. However, this must be  interpreted within the confines of a number of study limitations and, as such, the findings can neither support nor refute the effectiveness of physical activities.

Effect of a weight-loss program on mental stress-induced cardiovascular responses and recovery

Objective: We assessed the effect of weight loss on blood pressure (BP) and pulse rate during rest, psychological stress, and recovery after stress.

Methods: Two groups of men completed two mental stress tests 12 wk apart. The control group continued their usual diet, whereas the weight-loss group underwent a dietary weight-loss program in which they were randomized to a high-fruit/vegetable and low-fat dairy diet or a low-fat diet.

Results: Fifty-five men with a baseline BP of 125.9 ± 6.9/83.6 ± 7.1 mmHg (mean ± SD) completed the study (weight-loss group, n = 28; control group, n = 27). The weight-loss group lost weight (mean ± SEM, −4.3 ± 0.3 versus +0.4 ± 0.4 kg, P = 0.001) compared with controls and had a significant decrease in resting systolic BP (SBP; −2.0 ± 1.1% versus +2.0 ± 1.1%, P < 0.05). There was a greater decrease in SBP (P < 0.05) and pulse rate (P < 0.05) at all time points during the stress test in the weight loss compared with the control group. At week 12, SBP in 23 (82%) subjects in the weight-loss group and 24 (89%) in the control group returned to resting levels, with recovering levels in the weight-loss group returning to resting levels 6.1 ± 2.6 min earlier than in the control group (P < 0.05). There was an overall greater decrease in diastolic BP (DBP; P < 0.05) and DBP during recovery up to 27 min after stress (P < 0.05) in the high-fruit/vegetable and low-fat dairy diet group (n = 14) compared with the low-fat diet group (n = 14).

Conclusion: A 5% loss of weight decreased BP during rest and returned SBP to resting levels faster, thus decreasing the period of increased BP as a result of mental stress, which is likely to lower the risk of cardiovascular disease in the long term.