An evidence-based practice approach to improving nursing care of acute stroke in an Australian emergency department

Aims. The aim of this study was to improve the emergency nursing care of acute stroke by enhancing the use of evidence regarding prevention of early complications.
Background. Preventing complications in the first 24–48 hours decreases stroke-related mortality. Many patients spend considerable part of the first 24 hours following stroke in the Emergency Department therefore emergency nurses play a key role in patient outcomes following stroke.
Design. A pre-test/post-test design was used and the study intervention was a guideline for Emergency Department nursing management of acute stroke.
Methods. The following outcomes were measured before and after guideline implementation: triage category, waiting time, Emergency Department length of stay, time to specialist assessment, assessment and monitoring of vital signs, temperature and blood glucose and venous-thromboembolism and pressure injury risk assessment and interventions.
Results. There was significant improvement in triage decisions (21Æ4% increase in triage category 2, p = 0Æ009; 15Æ6% decrease in triage category 4, p = 0Æ048). Frequency of assessments of respiratory rate (p = 0Æ009), heart rate (p = 0Æ022), blood pressure (p = 0Æ032) and oxygen saturation (p = 0Æ001) increased. In terms of risk management, documentation of pressure area
interventions increased by 28Æ8% (p = 0Æ006), documentation of nil orally status increased by 13Æ8% (ns), swallow assessment prior to oral intake increased by 41Æ3% (p = 0Æ003), speech pathology assessment in Emergency Department increased by 6Æ1% (ns) and there was 93Æ5 minute decrease in time to speech pathology assessment for admitted patients (ns).
Relevance to clinical practice. An evidence-based guideline can improve emergency nursing care of acute stroke and optimise patient outcomes following stroke. As the continuum of stroke care begins in the Emergency Department, detailed recommendations for evidence-based emergency nursing care should be included in all multidisciplinary guidelines for the management of acute stroke.

Confidentiality and disclosure : assessment and intervention issues

This portfolio addresses the moral, ethical and legal issues that impact upon decisions to maintain or disclose confidential communications. The tensions and moral dilemmas that are created when a conflict between these aspects arises are considered. Risk assessment procedures that inform decisions to maintain or disclose confidential information are discussed, as are issues related to the practical implementation of planned interventions. The topic is addressed by firstly reviewing professional codes of conduct and legal requirements to maintain confidentiality. The limits of confidentiality and privileged communication are then reviewed together with legal requirements of “duty to warn” or “duty of care”. These requirements are then related to risk assessment procedures and relevant interventions. Four case studies that illustrate the practical application of assessment techniques in the decision process and planned interventions are presented. They cover such diverse topics as disclosure and suicidal intent, threat of harm to a third party, risk of transmission of the AIDS virus and “duty to warn” and maintenance of a minor’s confidential communications. The ways in which these issues were addressed and the outcome is presented. NOTE: All names and details that have the potential to identify the people whose cases are presented here have been changed to protect their anonymity.

Significance of environment in the assessment of sustainable development : the case for South West Victoria

The assessment of sustainable development is often based on the three pillars of sustainability model or triple bottom line using a set of indicators that evaluate the social, economic and environmental systems. It is thought that by measuring the performance of each system information can be gained about the sustainability of the whole system. However, this represents a disconnect between sustainability theory and the practice of sustainability evaluation as there is no attempt to evaluate if this assumption is true. During the development of a sustainability assessment framework for south west Victoria, Australia, it has become evident that this approach to sustainability assessment does not provide an accurate evaluation of system sustainability. Throughout this project, from stakeholder prioritisation of indicators to final multiple criteria analysis of sustainability, the environmental indicators were found to be the most important for the region’s sustainability. As a consequence, the assessment produced shows that in south west Victoria, sustainability is largely determined by the condition of the environment. This finding highlights the current disconnection between theory and the reality of sustainability. Thus, we discuss a framework for sustainability assessment that attempts to re-connect theory to practice.

Paradigmatic approach to managing complexity in knowledge-driven marketing

This research develops a measure of Customer Lifetime Value, extending existing measures, that provides organisations having large customer databases the means to place a financial value on customers. Using this measure, new models are developed that provide a framework to use knowledge to drive marketing decisions.

General practitioners' role in health assessment of humanitarian settlers

An approach to health assessment of humanitarian settlers was developed and evaluated from the perspective of general practitioners (GPs). While conducting assessment was found to be feasible, there were significant barriers which GPs without a primary interest in refugee health and those working in private practice may find difficult to transcend.

Advice on online assessment

A good deal of investigation and development is underway in Australian universities into the possibilities for effective and efficient on-line and computer-based assessment. The current commercial ‘virtual learning environments’, which integrate various curriculum elements at subject level into a single software portal, usually offer various built-in options for student assessment. As well, many on-line assessment initiatives are being locally developed to suit specific curriculum needs.

There are many reasons why on-line assessment is being adopted by Australian universities. Many academics are seeking to diversify assessment tasks, broaden the range of skills assessed and provide students with more timely and informative feedback on their progress. Others are wishing to meet student expectations for more flexible delivery and to generate efficiencies in assessment that can ease academic staff workloads. All staff involved in such initiatives are discovering they face a large number of technical and educational decisions.

The move to on-line and computer based assessment is a natural outcome of the increasing use of information and communication technologies to enhance learning. As more students seek flexibility in their courses, it seems inevitable there will be growing expectations for flexible assessment as well.

At the same time, in a climate of increasing academic workloads, the adoption of on-line assessment may help to manage large volumes of marking and assessment-related administration efficiently. The automation of routine on-line tasks, in particular, may have the potential in the long-term to provide time/cost-efficient student assessment, though the present evidence suggests that some on-line assessment, at least in the early stages, can add significantly both to staff workload and to overall expenses.

Risk assessment with female sex offenders : can women meet the criteria of community protection laws?

Although females represent a small proportion of the sex offender population, they occasionally appear before the courts under the current generation of laws intended to protect the public from high-risk sex offenders. In this context, practitioners are called upon to provide assessment of the risk these women pose for sexual re-offending. The primary issues addressed in this paper are related to the validity of conducting such risk assessments and providing professional opinions as to the risk of further sexual offences that may be committed by female offenders. The approach taken is to summarize briefly the available professional literature regarding female sex offenders, and then to present the findings of the relatively few empirical studies that address sexual recidivism in females. The final section examines the positions taken in the published works of various international experts regarding risk assessment with females, followed by conclusions and recommendations in light of the standards typically prescribed by community protection laws.

Current empirical assessment methods for adolescents and children who sexually abuse others

The assessment of adolescents and children who commit sexually abusive behavior is a complex and challenging task. Incorporating empirically based assessment methods into psychosexual evaluations promises appropriate coverage of relevant domains, sound interpretation of the meaning of data, reduced clinician biases and error, and greater certainty in decision-making. In this paper we review empirically-based assessment methods currently available for use in psychosexual assessment of adolescents and children who sexually abuse others. Our review describes the robustness of these measures and provides guidance for their appropriate use in assessment. The review highlighted that several empirically-based measures are suitable for clinical use with adolescents, but very little is available to guide assessment of children's abusive behavior per se.

Effectiveness of national elite sport policies : a multidimensional approach applied to the case of Flanders

While the results of nations in international sport competitions are most often used as an evaluation of effectiveness of elite sport policies, they do not take into account the long-term duration of an athletic career, nor the many confounding variables influencing international success. This paper argues that output evaluation is a one-sided approach to policy assessment. It applies a multidimensional approach to the measurement of the effectiveness of elite sports policy evaluation (meso-level) by examining a four-year cycle of elite sport policies in Flanders. This study endeavors to advance the development of a framework to assess effectiveness of elite sport policies of nations. Data were collected at multiple points of the input-throughput-output and feedback cycle. It was found that in spite of the increasing elite sport expenditures in Flanders (inputs), and notwithstanding the development of the throughputs (processes), this has not as yet lead to acceptable results (outputs) at an international level.

The architecture of peer assessment : do academically successful design students make good team mates in design assignments?

This paper considers the relationship between architecture and construction management students’ overall academic abilities (as measured by Weighted Average Marks [WAMs]), their peer ratings for contributions to team design assignments (as measured by an online Self-and-Peer-Assessment [SAPA] tool), and their specific abilities as building designers (as measured by grades in individual design assignments). The research was conducted to determine whether a student’s prior academic achievements might indicate how well they will work in teams. The research demonstrates a statistically significant relationship between WAMs and SAPA ratings indicating that academically successful students more often than not make good teammates. However, the study also highlights that when peers are assessing contributions to teamwork they are assessing skills and qualities in their teammates other than overall academic ability or the ability to design well. Whilst this study is largely located within the field of design, the findings are relevant to any group work where teachers aim to design assessment that unravels group and individual contribution.

Markers assistant – a software solution for the management of the assessment process

Technology-mediated instruction is changing the educational environment by adding another dimension to teaching and learning. Despite the advances in technology and the way we use technology, little attention has been given to providing technology solutions that help create, conduct, and manage the central task of assessment. Software to manage and conduct assessment presents many challenges. This article examines a stand-alone, flexible software environment designed to provide all the tools required to view, mark, store, and deliver results efficiently while improving the feedback to the students. A description of the software and its functions, the techniques and methods developed to overcome the limitations that software presents when used to conduct assessment is examined. Case studies are presented that describe: (a) the types of assessment the software has been used to conduct and manage; (b) the types of problems that were encountered; and (c) the solutions and techniques that were discovered and used to overcome the problems.

The pragmatic portfolio : an assessment approach for distributed learning

Portfolios, especially where they involve some use of or link to online technologies, are currently a popular focus for learning innovation in universities, drawing on a tradition of using portfolios in some areas of higher education and attempting to extend and broaden this practice. In some cases this focus has led to ambitious plans for whole-of-institution approaches, often involving significant technological development. However, the term portfolio can also cover a wider variety of possible learning and assessment activities and there are ways of using portfolios which, while quite traditional in their own form and approach, enable teachers to approach other aspects of their curriculum and pedagogy in far more innovative ways. This paper explores the conceptual basis on which the Department of Internet Studies at Curtin University of Technology is utilising a pragmatic approach to portfolio assessment within individual units of study, so as to enable a more thorough implementation of distributed learning. In this form of learning, where students regularly contribute to their own and others' learning through short tasks and conversations, the evidence of achievement is widely distributed and not easily accessible for either formative or summative assessment. As explained in the paper, students are required to collate, select, and then contextualise a sample of these numerous productive moments of their ongoing study. The paper concludes that while other goals for portfolio assessment (such as encouraging reflection) can also be used with this approach, its primary value is in unleashing the potential of social media creativity in a manner that motivates students via the requirement of assessment, enables feedback to be provided to guide learning, and which promotes shared responsibility between teachers and students in determining the kind and extent of their learning activities.

Genetic architecture of sexually selected traits - lessons from guppies

I discuss a number of experiments designed to explore the genetic basis of sexual ornamentation and associated life history traits in guppies. This system is unusual because of the large Y-linked contribution to ornamentation and male fitness, and because the Y-chromosome is implicated in inbreeding depression. I discuss the implications of intralocus sexual conflict for the evolution of sex-linkage in guppies and the potential for such a process to drive the evolutionary erosion of Y-chromosomes.

The impact structured patient assessment frameworks have on patient care: an integrative review

Aims and objectives:
To evaluate structured patient assessment frameworks' impact on patient care.

Background:
Accurate patient assessment is imperative to determine the status and needs of the patient and the delivery of appropriate patient care. Nurses must be highly skilled in conducting timely and accurate patient assessments to overcome environmental obstacles and deliver quality and safe patient care. A structured approach to patient assessment is widely accepted in everyday clinical practice, yet little is known about the impact structured patient assessment frameworks have on patient care.

Design:
Integrative review.

Methods:
An electronic database search was conducted using Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System, PubMed and ProQuest Dissertations and Theses. The reference sections of textbooks and journal articles on patient assessment were manually searched for further studies. A comprehensive peer review screening process was undertaken. Research studies were selected that evaluated the impact structured patient assessment frameworks have on patient care. Studies were included if frameworks were designed for use by paramedics, nurses or medical practitioners working in prehospital or acute in-hospital settings.

Results:
Twelve studies met the inclusion criteria. There were no studies that evaluate the impact of a generic nursing assessment framework on patient care. The use of a structured patient assessment framework improved clinician performance of patient assessment. Limited evidence was found to support other aspects of patient care including documentation, communication, care implementation, patient and clinician satisfaction, and patient outcomes.

Conclusion:
Structured patient assessment frameworks enhance clinician performance of patient assessment and hold the potential to improve patient care and outcomes; however, further research is required to address these evidence gaps, particularly in nursing.

Relevance to clinical practice:
Acute care clinicians should consider using structured patient assessment frameworks in clinical practice to enhance their performance of patient assessment.

Comparison of food industry policies and commitments on marketing to children and product (re)formulation in Australia, New Zealand and Fiji

Unhealthy food environments are known to be major drivers of diet-related non-communicable diseases globally, and there is an imperative for major food companies to be publicly accountable for their actions to improve the healthiness of food environments. This paper examines the prevalence of publicly available policies and commitments of major packaged food and soft drink manufacturers, and fast-food restaurants in Australia, New Zealand and Fiji with respect to reducing food marketing to children and product (re)formulation. In each country, the most prominent companies in each sector were selected. Company policies, commitments and relevant industry initiatives were gleaned from company and industry association websites. In Australia and New Zealand, there are a higher proportion of companies with publicly available marketing and formulation policies than in Fiji. However, even in Australia, a large proportion of the most prominent food companies do not have publicly available policies. Where they exist, policies on food marketing to children generally focus on those aged less than 12, do not apply to all types of media, marketing channels and techniques, and do not provide transparency with respect to the products to which the policies apply. Product formulation policies, where they exist, focus mostly on salt reduction and changes to the make-up of overall product portfolios, and do not generally address saturated fat, added sugar and energy reduction. In the absence of strong policies and corresponding actions by the private sector, it is likely that government action (e.g. through co-regulation or legislation) will be needed to drive improved company performance.