Ethical dilemmas of a large national multi-centre study in Australia

Aims and objectives: To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study.

Background: Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects.

Methods: The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC.

Results: Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study.

Conclusions: Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services.

Relevance to clinical practice: The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.

Integrating farm production and natural resource management in Tasmania, Australia

This paper reports on the social learning from a project aimed to increase the knowledge and capacity of a group of farmers in Tasmania, Australia, to reduce the impacts of intensive agriculture on soil health and waterways, and to optimise the efficient use of on-farm inputs. The plan-do-check-review cycle adopted in this project required the farmers to assess current management practices, identify where to make changes, implement changes and monitor for improvements. The success of the project was due to careful attention to social processes as well as technical input. The combination of group activities with individual mentoring and one-to-one advice was key to the success of this project in enabling farmers to undertake on-farm action.

There is value in social learning that included developing relationships, using one-to-one contact and group workshops together with expert input when working with farmers to tackle some difficult and complex interrelated natural resource management and production issues. Sufficient time must be allowed for the process of facilitating good practice in natural resource management, particularly when addressing systemic environmental impacts. Practical operational recommendations are presented on communication, feedback, focus of activities and meeting content, as these will be useful to other project officers and facilitators working with farmer groups.

Implementing a journal club in a palliative care setting : a link in the chain of evidence-based practice

This paper describes the implementation and evaluation of a journal club in a privately funded palliative care unit. Journal club meetings were initiated as part of a quality improvement process to foster the uptake of evidence-based practice. Nurses were presented with research articles each month and discussions were conducted focussing on methodological considerations of the research and implications of the research for patient care. The maximum number of attendees at any one meeting was nine and the minimum number was four. Overall, evaluations were positive about all aspects of the meetings. Attendees found that the selected articles were relevant, providing new information, stimulated discussion and reflection on clinical practice and encouraged further reading. One of the positive aspects of the meetings identified by participants was the facilitation style that enabled discussion in a safe and supportive environment. An important outcome of the meetings is the potential to explore evidence-based practices relevant to palliative care and to implement new practices or revise existing ones. As part of this process practice changes and clinical guidelines have been implemented. A dedicated facilitator with university links and a supportive organisational culture promoted club meetings as a practical way to provide clinical nurses with the opportunity to explore evidence-based research in the area of palliative care.

Moving beyond resistance to restraint minimization : a case study of change management in aged care

Aim: This case study describes a quality initiative to minimize restraint in an Australian residential aged care facility.

Approach: The process of improving practice is examined with reference to the literature on implementation of research into practice and change management. The differences between planned and emergent approaches to change management are discussed. The concepts of resistance and attractors are explored in relation to our experiences of managing the change process in this initiative. The importance of the interpersonal interactions that were involved in facilitating the change process is highlighted.

Implications: Recommendations are offered for dealing with change management processes in clinical environments, particularly the need to move beyond an individual mind-set to a systems-based approach for quality initiatives in residential aged care.

Disorienting VET : enhancing VET practice through transformative learning theory

This paper will explore the contention that Australian VET may be an environment in which transformative learning can occur, and indicate ways to enhance VET practice in relation to this kind of learning. Mezirow’s theory of transformative learning is surveyed to provide background. Two examples of VET programs are described to show how VET can serve as a context for transformative learning. It is suggested that if there are VET programs that produce conditions favourable to transformative learning, then practitioners working in these areas can enhance their practice through familiarity with the features of transformative learning and ways that have been promoted for the support and facilitation of transformative learning.

Phenomenon of ordinariness in nursing

This phenomenological research aimed to illuminate the nature and effects of ordinariness in nursing and to discover whether the phenomenon enhanced the nursing encounter. The researcher worked as a participant observer with six registered nurses in a Professorial Nursing Unit. Following each interaction, the researcher wrote her impressions in a personal-professional journal and audiotaped conversations with the respective nurses and patients to gain their impressions. Using a theoretical framework of the phenomenological concepts of lived experience, Dasein, Being-in-the-world and fusion of horizons as an underpinning methodology, an initial hermeneutical analysis and interpretation of the impressions generated qualities and activities indicative of the aspects of the phenomenon of ordinariness in nursing. The second phase of the analysis and interpretation sought to illuminate the nature of the phenomenon itself. Eight actualities of the nature of the phenomenon emerged: 'allowingness,' 'straightforwardness,' 'self-likeness,' 'homeliness,' 'favourableness,' 'intuneness,' 'lightheartedness' and 'connectedness.' These actualities were described in relation to the phenomenon of interest. The effects of the phenomenon were the creative potential to enhance the nursing encounter and included many and various effects of facilitation, fair play, familiarity, family, favouring, feelings, fun and friendship. The research found that nurses and patients shared a common sense of humanity, which enhanced the nursing encounter. Within the context of caring, the nurses were ordinary people, perceived as being extraordinarily effective, by the very ways in which their humanness shone through their knowledge and skills, to make their whole being with patients something more than just professional helping. The shared sense of ordinariness between nurses and patients made them as one in then- humanness and created a special place, in which the relative strangeness of the experience of being in a health care setting, could be made familiar and manageable.

Marketing across cultures : an investigation into place specific dimensions of service quality in sport

Abstract The purpose of this study was to identify place-specific dimensions of service quality in spectator sport settings and determine if the importance of these dimensions differed across cultures. The study was limited to the soccer industry and involved the collection of responses from identified soccer spectators to a range of items presented in a survey instrument. The survey was distributed to respondents face-to-face on a match day of the club they supported, or mailed to their home address. Responses were obtained from spectators from two clubs from Australia (n=277), one club from the USA (n=199), one club from the Netherlands (n=245) and one federation from Malaysia (n= 100). Based on the findings of a number of authors, six categories of potential place-specific dimensions of service quality in spectator sport settings were created and the research instrument contained a number of items that could be categorised under one of these headings. These categories were Home, Religion, Social facilitation, Sensory, Uncertainty of outcome, and Personal attention. In this thesis it was assumed that place-specific service quality issues are similar for sport spectators of different cultures, although differences in degree of importance of these dimensions (etic approach) were likely to emerge. In other words, although it was expected dimensions per country to be similar, differences in degree of importance of these dimensions were expected. Given the lack of confirmatory statistical evidence pertaining to the specific country samples, it was concluded that differences per country are likely to be more than just differences in degree. Both the overall structure and structures per country could not be confirmed, and hence the conclusion was drawn that differences in nature between the countries were present. In other words, what is a dimension of place-specific service quality in one country is not necessarily a dimension in another country. The results of a content analysis of ‘core component’ structures per country compared with a (full sample) core component structure delivered six components (referred to as place-specific dimensions of service quality) that were defined as Home, Hedonist, Religious follower, Safe atmosphere, Hospitality and Personal Attention. It was found that in most cases the cultural orientation of soccer spectators reflects the cultural orientation of the country as a whole as proposed by Hofstede (1991). However, in line with Huntington (1997), it was also argued that grouping people based on their country of origin as a proxy for their cultural orientation, will increasingly lead to flawed and incomplete research findings. As noted by Yoo etal. (1999), the identification of a person's cultural orientation is likely to deliver more direct results when measured at the individual level In that regard it is concluded that it may seem prudent to view Hofstede's dimensions of culture with increased conceptual scrutiny. Although having been replicated in multiple studies, it becomes increasingly unlikely that Hofstede's dimensions cover the complete spectrum of an individual person's cultural orientation. In conclusion, this study identified that soccer spectators (from a number of clubs) from Australia, the USA, the Netherlands and to a lesser extent Malaysia, perceive a range of place-specific service quality dimensions in spectator spoil settings to be important when visiting a soccer match. Before research into satisfaction with and value of place-specific dimensions of the spectator sport service product is initiated, it is pertinent the identified dimensions are further explored and confirmed in different country (culture) settings. The confusion that still exists about the place of the value concept (in relation to quality and satisfaction), where Holbrook (1994) defines quality as a type of value and Chelladurai and Chang (2000) argue that value is a type of quality, further underpins this necessity. It needs to be clear what are the targets of service quality before this information is integrated in larger holistic research frameworks. In the final section of the thesis a conceptual model for international services marketing research in the sport industry was presented as a first attempt to integrate the findings of this research and other researchers.

Evaluation of Australian undergraduate engineering management education for flexible delivery

This thesis examines issues in Australian undergraduate engineering management studies in the context of flexible learning delivery. It is proposed that, within an Australian context: a) the management skills and competencies required by graduate engineers can be determined and classified on a rational basis, permitting an educational focus on those elements most appropriate for graduates; and b) on-line and other computer-based technologies are a practical and effective method for the support of undergraduate engineering management studies. The doctoral project incorporates: • an examination of the nature of engineering management; • a review of the relevant literature establishing the importance of management studies in undergraduate engineering courses; • a review of historical and recent developments in Australian undergraduate engineering management studies; • an investigation of the management skills and competencies required by graduate engineers - based on original research; • an examination of flexible delivery of engineering education - based on professional practice experience; and • an evaluation of case studies of flexible delivery of engineering management education - based on original research and professional practice experience. A framework of ranked classified management skills is developed. Broadly, the ranking framework is generic professional skills, followed by general management skills and technical discipline specific management skills, followed by other professional discipline skills and theoretical skills. This framework provides a rational basis for design of undergraduate engineering management studies. This is supplemented by consideration of the management skills required for the future of engineering practice. It is concluded that undergraduate engineering management education is well suited to delivery and support by on-line and computer-based technology. Recent developments in improved access to the Internet, software systems for on-line collaboration and changes in copyright legislation to create a broad-based right to communication via on-line media have contributed to the facilitation of on-line delivery of teaching and learning. It is noted that though many on-line infrastructure issues have been satisfactorily resolved, higher level issues will emerge as being crucial, including the academic staff development and reward for operating in an online teaching environment and the financial sustainability of on-line development and delivery of courses.

Research on school and community-based curriculum practice in aboriginal, multicultural and migrant education

This research studies some key problems in relation to curriculum reform in multicultural and migrant education: social concepts of multicultural education, divergent curriculum theories informing practice, the facilitation process in regard to project self-study and action research and the development of cultural perspectives in general curriculum pedagogy.

Canadian nursing students' coping strategies for learning online

This research reports on the experiences of Canadian nursing students as they coped with learning online, exploring the strategies that they used to learn effectively. The findings identified aspects of course design and online facilitation that will help students cope with the lack of social presence in the online environment.

From rural beginnings to statewide roll-out : evaluation of facilitator training for a group-based diabetes prevention program

Objective: To evaluate the approach used to train facilitators for a large-scale group-based diabetes prevention program developed from a rural implementation research project.

Participants: Orientation day was attended by 224 health professionals; 188 submitted the self-learning task; 175 achieved the satisfactory standard for the self-learning task and attended the workshop; 156 completed the pre- and post-training questionnaires.

Main outcome measures: Two pre- and post-training scales were developed to assess knowledge and confidence in group-based diabetes prevention program facilitation. Principal component analysis found four factors for measuring training effectiveness: knowledge of diabetes prevention, knowledge of group facilitation, confidence to facilitate a group to improve health literacy and confidence in diabetes prevention program facilitation. Self-learning task scores, training discontinuation rates and satisfaction scores were also assessed.

Results: There was significant improvement in all four knowledge and confidence factors from pre- to post-training (P < 0.001). The self-learning task mean test score was 88.7/100 (SD = 7.7), and mean assignment score was 72.8/100 (SD = 16.1). Satisfaction with training scores were positive and 'previous training' interacted with 'change in knowledge of diabetes prevention program facilitation' but not with change in 'confidence to facilitate.'

Conclusions: The training program was effective when analysed by change in facilitator knowledge and confidence and the positive mean satisfaction score. Learning task scores suggest tasks were manageable and the requirement contributed to facilitator self-selection. Improvement in confidence scores in facilitating a group-based diabetes prevention program, irrespective of previous training and experience, show that program-specific skill development activities are necessary in curriculum design.

Impact of leadership and power on successful ERP adoption

Case study research investigating the impact of culture upon a Hong Kong based construction contractor's leadership in implementing an Enterprise Resource Planning (ERP) system unearthed rich data relating to the predominantly Hong Kong Chinese cultural perspective of power, leadership and followership. Intimately involved participants were surveyed using both structured and semi-structured interviews. The study's focus was centred upon the interplay between culture, power and how people interact with the way that the ERP is used and how teams of people involved in the ERP implementation, perceived the supportive nature of the organisation's leadership in deploying the ERP. A culturally sensitive empowering leadership style was a significant issue in successfully project managing and deploying the ERP. Understanding how teams and their leaders interact and how power and trust influences the facilitation role of leadership is also useful in gauging how an ERP can be most effectively deployed.

The development of a network for community based obesity prevention : the CO-OPS collaboration

Background: Community-based interventions are a promising approach and an important component of a comprehensive response to obesity. In this paper we describe the Collaboration of COmmunity-based Obesity Prevention Sites (CO-OPS Collaboration) in Australia as an example of a collaborative network to enhance the quality and quantity of obesity prevention action at the community level. The core aims of the CO-OPS Collaboration are to: identify and analyse the lessons learned from a range of community-based initiatives aimed at tackling obesity, and; to identify the elements that make community-based obesity prevention initiatives successful and share the knowledge gained with other communities.
Methods: Key activities of the collaboration to date have included the development of a set of Best Practice Principles and knowledge translation and exchange activities to promote the application (or use) of evidence, evaluation and analysis in practice.
Results: The establishment of the CO-OPS Collaboration is a significant step toward strengthening action in this area, by bringing together research, practice and policy expertise to promote best practice, high quality evaluation and knowledge translation and exchange. Future development of the network should include facilitation of further
evidence generation and translation drawing from process, impact and outcome evaluation of existing communitybased interventions.
Conclusions: The lessons presented in this paper may help other networks like CO-OPS as they emerge around the globe. It is important that networks integrate with each other and share the experience of creating these networks.

Differential modulation of spinal and corticospinal excitability during drop jumps

Previously it was shown that spinal excitability during hopping and drop jumping is high in the initial phase of ground contact when the muscle is stretched but decreases toward takeoff. To further understand motor control of stretch-shortening cycle, this study aimed to compare modulation of spinal and corticospinal excitability at distinct phases following ground contact in drop jump. Motor-evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS) and H-reflexes were elicited at the time of the short (SLR)-, medium (MLR)-, and long (LLR, LLR2)-latency responses of the soleus muscle (SOL) after jumps from 31 cm height. MEPs and H-reflexes were expressed relative to the background electromyographic (EMG) activity. H-reflexes were highly facilitated at SLR (172%) and then progressively decreased (MLR = 133%; LLR = 123%; LLR2 = 110%). TMS showed no effect at SLR, MLR, and LLR, whereas MEPs were significantly facilitated at the LLR2 (122%; P = 0.003). Background EMG was highest at LLR and lowest at LLR2. Strong H-reflex facilitation at the beginning of the stance phase indicated significant contribution of Ia-afferent input to the α-motoneurons during this phase that then progressively declined toward takeoff. Conversely, corticospinal excitability was exclusively increased at the phase of push off (LLR2, ∼120 ms). It is argued that corticomotoneurons increased their excitability at LLR2. At LLR (∼90 ms), Ia-afferent transmission as well as corticospinal excitability was low, whereas background EMG was high. Therefore it is speculated that other sources, presumably subcortical in origin, contributed to the EMG activity at LLR in drop jumps.