Assessment of variation in the alberta context tool : the contribution of unit level contextual factors and practice specialty in Canadian pediatric acute care settings

Background: There are few validated measures of organizational context and none that we located are parsimonious and address modifiable characteristics of context. The Alberta Context Tool (ACT) was developed to meet this need. The instrument assesses 8 dimensions of context, which comprise 10 concepts. The purpose of this paper is to report evidence to further the validity argument for ACT. The specific objectives of this paper are to: (1) examine the extent to which the 10 ACT concepts discriminate between patient care units and (2) identify variables that significantly contribute to between-unit variation for each of the 10 concepts.

Methods: 859 professional nurses (844 valid responses) working in medical, surgical and critical care units of 8 Canadian pediatric hospitals completed the ACT. A random intercept, fixed effects hierarchical linear modeling (HLM) strategy was used to quantify and explain variance in the 10 ACT concepts to establish the ACT’s ability to discriminate between units. We ran 40 models (a series of 4 models for each of the 10 concepts) in which we systematically assessed the unique contribution (i.e., error variance reduction) of different variables to between-unit variation. First, we constructed a null model in which we quantified the variance overall, in each of the concepts. Then we controlled for the contribution of individual level variables (Model 1). In Model 2, we assessed the contribution of practice specialty (medical, surgical, critical care) to variation since it was central to construction of the sampling frame for the study. Finally, we assessed the contribution of additional unit level variables (Model 3).

Results: The null model (unadjusted baseline HLM model) established that there was significant variation between units in each of the 10 ACT concepts (i.e., discrimination between units). When we controlled for individual characteristics, significant variation in the 10 concepts remained. Assessment of the contribution of specialty to between-unit variation enabled us to explain more variance (1.19% to 16.73%) in 6 of the 10 ACT concepts. Finally, when we assessed the unique contribution of the unit level variables available to us, we were able to explain additional variance (15.91% to 73.25%) in 7 of the 10 ACT concepts.

Conclusion: The findings reported here represent the third published argument for validity of the ACT and adds to the evidence supporting its use to discriminate patient care units by all 10 contextual factors. We found evidence of relationships between a variety of individual and unit-level variables that explained much of this between-unit variation for each of the 10 ACT concepts. Future research will include examination of the relationships between the ACT’s contextual factors and research utilization by nurses and ultimately the relationships between context, research utilization, and outcomes for patients.

William Wardell's 1859 St John's College - a rare realisation of Pugin's ideal Catholic College?

William Wardell’s St John’s College, Sydney, considered the grandest and architecturally most distinguished university college in New South Wales, is an exceptional example of 19th century Gothic Revival architecture.  The information board outside the college states that St John’s is ‘a rare realisation of Pugin’s ideal Catholic College’ and further that ‘it demonstrates [Pugin]’s profound influence on the work of Wardell’. This is but a small part of the story. The commission for St John’s College was far more complex.  The correspondence between the architects, William Wardell, Edmund Blacket and others, and St John’s Council indicates that right from the beginning there was a general lack of understanding of Wardell’s original design concept for the building. This has continued to the present day, as evidenced by the information on the board outside St John’s College, in which it is incorrectly assumed that Wardell’s proposal included a quadrangle as featured in Pugin’s ‘ideal College’. This paper, based largely on primary sources, investigates such claims about St John’s, considers William Wardell and the Gothic Revival, examines St John’s College within the University of Sydney – its design and its translation and posits a few conclusions leading to new understandings.