Nurses' understanding of patient-centred care in Bhutan

Aim The purpose of the study was to explore nurses' perceptions and understanding of patient-centred care (PCC) in Bhutan. Background Nurses' perceptions and understanding of PCC in Bhutan are unknown. Methods A non-probability convenience sample was taken and a mixed method (quantitative and qualitative descriptive) used. Survey questionnaires were administered to 87 Bhutanese nurses in three types of hospitals -- the National Referral Hospital, the regional referral hospital and the district hospital. Descriptive statistics including frequency distribution, mean and standard deviation (SD) were used for analysis. Spearman's correlation coefficients were used to investigate relationships between demographic variables. Results The nursing labour force in Bhutan knows which behaviours are considered necessary for practising PCC. The mean (SD) rating of behaviours considered critical for practising PCC was 4.29 (0.22), five being the highest score. Bhutanese nurses described PCC, according to qualitative descriptive analysis, as being based on individual patient assessment (22/87 or 25% of respondents), using a holistic model of care (38/87 or 44%) that was based on evidence (38/87 or 44%). A higher level of education (79/87 or 91%) was found to be the main factor that would facilitate the development of PCC, while inadequate staffing, in terms of insufficient numbers of staff and lack of advanced practitioners (56/87 or 64%), was revealed as the main factor that hinders development of PCC. Conclusion Bhutanese nurses believed certain behaviours were critical to PCC. Reform of higher nursing education, putting an emphasis on PCC, would improve nursing practice and increase its scope.

Demonstrable professionalism : linking patient-centred care and revalidation

The move by the Medical Board of Australia to commence a conversation with the medical profession about revalidation reflects that patient-centred care is at the heart of good medical practice. Patients judge their doctors' commitment to them based on whether their individual interactions with doctors meet their needs. We argue that ensuring that doctors are continuing to perform at a level that the community regards as acceptable is a demonstration of an individual doctor's professionalism and thus their commitment to patient-centred care. This impacts on the profession as a whole, which needs to commit to what we call 'demonstrable professionalism' - the ongoing and active demonstration of performance that the community regards as acceptable. This needs to be supported by organisations in which doctors work, reflecting the importance of organisational context to clinical practice. Revalidation processes thus need both to reflect the work of doctors and be meaningful to the community. The move to consider revalidation of doctors by regulatory authorities should not be seen by the profession as a threat, but more as an opportunity to demonstrate the profession's commitment to patient-centred care

Infusing instructional design principles into an active student-centred social learning framework

Social and participatory media offer a plethora of ways for students to communicate, collaborate, and learn in schools. Using a social learning approach, Casey (2013a) investigated ways that social media could be integrated into Australian public high school classrooms to enhance student learning. In the process, she developed a social learning framework as discussed in Casey (2013b). Similarly, Davidson-Shivers and Hulon (2013; Hulon & Daidson-Shivers, 2013) suggest ways to employ ID principles to prepare college instructors and pre-service teachers to integrate technology into classrooms. Prior to that, Davidson-Shivers with Rasmussen (2006) developed an instructional design (ID) model for creating effective Web-based learning environments. Through collaboration, Casey and Davidson-Shivers consider a wide range of social learning and instructional design principles and approaches to help develop frameworks for new media integration that can work within varying levels of education.

Training AAC users in user-centred design

User-centred design (UCD) with a focus on usability provides product developers with a design approach in which users are involved in every stage of the process: when gathering requirements; when evaluating alternative designs; and when evaluating interactive prototypes.The characteristics of people who use augmentative and alternative communication (AAC) make it difficult to follow a truly UCD approach, which in part may contribute to the high rejection of AAC devices. Training workshops have been delivered to introduce users and AAC professionals to the UCD process.Initial feedback indicates that they feel more empowered to evaluate systems and to engage in the design of new systems after attending the workshop.

Understanding the experience of inpatient rehabilitation: insights into patient-centred care from patients and family members

The aim of the study was describe the experiences, needs and preferences of recent inpatients of a rehabilitation centre, and the needs of their families. Data were collected in four focus groups, two with patients (n = 13) who had recently completed inpatient rehabilitation following an illness, injury or elective surgery, and two with family members (n = 11). During the focus groups, two researchers facilitated discussion on any topic that participants considered important to the experience of inpatient rehabilitation; participants were encouraged to describe their care, needs and preferences. The focus group discussions were audio-taped and transcribed verbatim. Field notes were hand recorded. Data were analysed and collated into themes. Six key themes emerged. Participants wanted: interactions with friendly, empathetic staff; regular contact with senior staff and all staff to introduce themselves by name and profession; timely communication of accurate information; and rehabilitation services seven days a week. The physical environment had both positive and negative effects on patient well-being. Patients with complex or atypical circumstances required special attention to ensure their needs were met. In conclusion, patients and families identified six important issues that need to be considered during inpatient rehabilitation.

Transplantation of the heart after circulatory death of the donor: time for a change in law?

Australia has a shortfall in donated hearts for transplantation.Hearts are usually procured from brain dead donors, but procurement from circulatory dead donors is a potential additional source.However, heart transplantation after circulatory death of the donor may not conform to the dead donor rule.An amendment in law is required to permit heart procurement for transplantation after circulatory death.

From exclusion to agency in Papua: Pagar Adat Papua (the Papuan Customary Framework) as a culture- centred approach to HIV and AIDS communication

 This thesis examines the existing constructions, multiple discourses and framings of the HIV and AIDS epidemic in the Mee community of Papua, Indonesia, through the lens of a culture-centred approach to HIV and AIDS communication.

Tackling disadvantage through student-centred learning - exploring 'Worlds of Work' in the Melbourne CBD

As the educational landscape increasingly mirrors deepening socio-economic cleavages within Australian society, the disparity in educational outcomes has been identified as one of the biggest challenges confronting secondary schooling. In contrast with most OECD countries, family background remains the most important determinant of educational achievement in Australia. More and more, schools are defined by location, reinforcing what has been dubbed the 'circular pattern of disadvantage'. At the same time, recognition of strong links between outcomes, socio economic status and location has elicited growing calls for systematic redefining of learning experiences and the public education framework. Focus on flexible, rigorous, community-oriented, person-centred learning opportunities has predicated multiple mentoring and youth schemes and has guided policy. Recognition of the need to re-engage Year 9 and 10 students underpinned development of VELS, for instance; it has also directed the programming priorities of Education Foundation Australia (EFA). This paper will discuss first, how schools perceive the programs have made a difference to both individual students and the curriculum offered in the schools, and second, how the experiences and activities provided through the program have changed the expectations and aspirations that many of the participants have in regard to how they perceive their future, their engagement with school and their careers. Both City Centre and Worlds of Work (WOW) program have received a very positive student response to real world activities that have demonstrably enhanced the development of reflective processes, interpersonal and social skills and social networks. Practical outcomes have included self-organised work experience, the development of mentor relationships and the re-engagement of some students with the schooling process. Interview data confirmed EFA's assessment that its programs have greatest impact when integrated into a school's curriculum rather than as "stand alone" electives.

Caution: deceased donor organ commercialism!

In the past 3 years there have been attempts to counter the international campaignagainst a market in organs from the living. In parallel to these attempts,support for a market in organs from the deceased has gained some traction. Inthis article we describe the various forms of this phenomenon, analyze itsimplications, and call upon policy makers to take steps to halt its progress.

Is client-centred care planning for chronic disease sustainable? Experience from rural South Australia

This qualitative evaluation of a chronic disease self-management project in rural South Australia considers the sustainability of client-centred care planning under current organisational and funding arrangements. The study involved consultation with a range of five stakeholder types over two stages (40 in the beginning stage and 39 in the middle stage) about their satisfaction with the care planning and self-management approach used in the project. All stakeholder types valued the client-centred approach because they perceived that clients were better able to accept and deal with the long-term management of their condition. However, this required that care planning should deal with a wider range of issues than just medical management, and so it took longer, which raised its sustainability in general practice under the current funding through the national health insurance programme (Medicare). The study concludes that sustainability may be addressed through further research into the role of and funding for peer-led self-management groups and the employment of care planners in organisational settings that are conducive to a client-centred approach.

A review of the game-centred approaches to teaching and coaching literature since 2006

Background: In 2006, Oslin and Mitchell published a review of the game-centred approaches (GCAs) to teaching and coaching literature highlighting a number of core concepts thought to provide justification for the use of GCAs including (a) its potential to enhance participant motivation, (b) potential for tactical transfer, and (c) development of decision-making skills and effective decision-makers. Oslin and Mitchell also suggested recommendations for future GCA research.Purpose: The purpose of this paper was threefold: (a) to present a review of Anglophone research into GCAs building on the previous review of Oslin and Mitchell published in 2006; (b) to identify new trends in research since 2006; and (c) to investigate the extent to which the initial suggestions and future research directions suggested by Oslin and Mitchell have been addressed.Data collection: GCA literature since 2006 was searched systematically using a three-phase approach. Phase 1 included initial searches of the EBSCO database using terms associated with GCAs and their acronyms (e.g. TGfU (teaching games for understanding), GS (Game Sense), etc.). Phase 2 expanded the search adopting more generic terms from keywords located in the recent literature (e.g. teaching games, tactical development, game performance, etc.). Multiple searches through the EBSCO database were conducted, whereby key terms were cross-referenced until a saturation point was reached. Phase 3 involved removing those publications that were not empirical, peer reviewed, intervention studies or published in English.Findings: Forty-four studies on GCA implementation were identified and the methodological and substantive nature of these studies was examined. The review noted two positive trends: (a) the expansion of research which included the growth of research on GCAs in Europe and Southeast Asia and (b) an increased amount of research in the affective domain. The review found, however, that a number of key challenges remain within GCA research, which include (a) the need for improved articulation of GCA verification procedures; (b) further assessment of tactical awareness development; (c) extended inquiry about GCAs in coaching contexts; (d) more research into ‘newer’ GCAs (i.e. PP (play practice), IGCM (invasion game competence model) and TDLM (tactical decision learning model)); (e) use of longitudinal research designs; (f) inadequate length of GCA induction and training for teachers and coaches, and (g) examination of GCAs in terms of fitness and special populations.Conclusions: GCA pedagogies are of significant importance as they have the potential to promote change within current adult-centric cultures of youth sport and encourage engagement in physical activity over the life course. To meet these needs, it is recommended that GCA research undergo continued expansion with the use of research designs and data collection techniques that aid the examination of different philosophical understandings of GCAs (e.g. ethnographic, phenomenological and psycho-phenomenological). These are paramount to the exploration of ‘who the individual is’ and ‘how the learner is motivated to continue to participate’ and further permit the in-depth, contextual and ecological analysis of GCA interventions that Oslin and Mitchell recommended in their previous review.

Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting.

AIMS AND OBJECTIVES: This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. BACKGROUND: Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. DESIGN: A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. METHODS: A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. FINDINGS: Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. CONCLUSIONS: The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication management in an acute hospital setting. Language discourses shaped and were shaped by complex power relations between patients and clinicians and among clinicians themselves. RELEVANCE TO CLINICAL PRACTICE: Clinicians need to be encouraged to have regular conversations to talk about and challenge each other's practices. More emphasis should be placed on ensuring that patients are given opportunities to voice their concerns about how their medications are managed.