Cross-cultural examination of the structure of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R)

This study investigated the cross-cultural factor stability and internal consistency of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R); a measure of the quality of postoperative pain management employed internationally. We conducted exploratory factor analysis (EFA) of APS-POQ-R data from two point-prevalence studies comprising 268 and 311 surveys of Danish and Australian medical-surgical patients. Parallel analysis indicated four and three factor solutions for Danish and Australian patients respectively, which accounted for 58.1% and 52.9% of variance. Internal consistency was unsatisfactory among both Danish (Cronbach α=.54) and Australian (Cronbach α=.63) cohorts. There was a high degree of between-group similarity in item-factor loadings of variables coded as "pain experience", but not "pain management". This reflected cross-cultural differences in ratings of treatment satisfaction. For Danish patients, satisfaction was associated with the degree of pain severity and activity interference whereas for Australian patients, satisfaction was associated with their perceived ability to participate in treatment. To facilitate further cross-cultural comparison, we compared our findings to past research conducted in the U.S. and Iceland. EFA supported the construct validity of the APS-POQ-R as a measure of "pain experience", but indicated that items measuring "pain management" may vary cross-culturally. Findings highlighted the need for further validation of the APS-POQ-R internationally. PERSPECTIVE: This study revealed the APS-POQ-R as a valid measure of postoperative pain experience for Danish and Australian patients. Measures of patients' perception of pain management were not robust to group differences in treatment expectations and demonstrated cross-cultural instability. Results highlighted difficulties in establishing stable cross-cultural, cross-population subscales for the APS-POQ-R.

Understanding feedback report uptake: process evaluation findings from a 13-month feedback intervention in long-term care settings

BACKGROUND: Long-term care settings provide care to a large proportion of predominantly older, highly disabled adults across the United States and Canada. Managing and improving quality of care is challenging, in part because staffing is highly dependent on relatively non-professional health care aides and resources are limited. Feedback interventions in these settings are relatively rare, and there has been little published information about the process of feedback intervention. Our objectives were to describe the key components of uptake of the feedback reports, as well as other indicators of participant response to the intervention. METHODS: We conducted this project in nine long-term care units in four facilities in Edmonton, Canada. We used mixed methods, including observations during a 13-month feedback report intervention with nine post-feedback survey cycles, to conduct a process evaluation of a feedback report intervention in these units. We included all facility-based direct care providers (staff) in the feedback report distribution and survey administration. We conducted descriptive analyses of the data from observations and surveys, presenting this in tabular and graphic form. We constructed a short scale to measure uptake of the feedback reports. Our analysis evaluated feedback report uptake by provider type over the 13 months of the intervention. RESULTS: We received a total of 1,080 survey responses over the period of the intervention, which varied by type of provider, facility, and survey month. Total number of reports distributed ranged from 103 in cycle 12 to 229 in cycle 3, although the method of delivery varied widely across the period, from 12% to 65% delivered directly to individuals and 15% to 84% left for later distribution. The key elements of feedback uptake, including receiving, reading, understanding, discussing, and reporting a perception that the reports were useful, varied by survey cycle and provider type, as well as by facility. Uptake, as we measured it, was consistently high overall, but varied widely by provider type and time period. CONCLUSIONS: We report detailed process data describing the aspects of uptake of a feedback report during an intensive, longitudinal feedback intervention in long-term care facilities. Uptake is a complex process for which we used multiple measures. We demonstrate the feasibility of conducting a complex longitudinal feedback intervention in relatively resource-poor long-term care facilities to a wider range of provider types than have been included in prior feedback interventions.

Health services should collect feedback from inpatients at the point of service: opinions from patients and staff in acute and subacute facilities

OBJECTIVE: Point of service feedback (POSF) enables patients to give health services feedback about their experiences during or immediately after care. Despite the increasing use of POSF, little is known regarding patients' and staffs' opinions of this practice and whether they consider it acceptable or useful. The study aimed to determine patient and staff opinions regarding POSF. DESIGN: A cross-sectional survey. SETTING: Acute and subacute healthcare facilities. PARTICIPANTS: Two hundred and forty-seven patients and 221 staff. RESULTS: Participants indicated that patients should be invited to evaluate health services when they are in hospital or subacute care and improving services was the most important reason for doing so. Staff indicated that:• collecting patients' feedback during their stay was an important part of providing care and not an interruption to it (n = 187 of 221, 85%).• collecting patients' feedback was best done with a variety of methods; talking directly with patients during their stay was the preferred option (n = 161 of 219, 74%).More patients preferred to:• give feedback during their stay (51%) than after discharge from care (15%).• give feedback by talking with someone (45%) than completing a questionnaire (31%).Some patients (14%) were concerned about reprisal from staff if they gave negative feedback. CONCLUSIONS: POSF can be acceptable and useful for evaluating health services and should be incorporated into a person-centred approach that allows patients to choose from a variety of feedback options both during and after their stay. To be most useful, feedback should be incorporated into a quality improvement system.

Responding to student evaluation of teaching : closing the loop

Our undergraduate curriculum focuses on preparing students to be critical thinkers, problem solvers, and knowledgeable, responsible information technology (IT) professionals. Students often question the relevance of core subjects which are designed to introduce and develop these attributes; such units regularly perform poorly in student evaluation of teaching. Although these subjects are strongly grounded in meeting industry expectations regarding employability skills, students do not value the learning as the curriculum is deemed non-technical and not worthy of inclusion in an IT qualification. As these are core subjects, improving student perceptions and learning outcomes is of critical importance. Simply responding to student feedback received via student evaluation of teaching had not resulted in any improvement; so a holistic approach was adopted. A workshop was organised to explore the issues and develop a strategy to improve outcomes and perceptions of these subjects. Rather than addressing student feedback specifically, the underlying issues that led to students’ negative perceptions were identified and addressed. Recommendations were implemented in 2014 resulting in improvements in student evaluation for relevant subjects. In this paper, we will discuss the process that was adopted to respond effectively to student evaluations, and explore the impact that this had on them.

An evaluation of an action research nursing documentation project

AIMS AND OBJECTIVES: The aim of this study is to describe healthcare professionals' experiences and perceptions of an intervention implemented in an action research project conducted to improve nursing documentation practices in four municipalities in Norway.

BACKGROUND: Documentation of individualized patient care is a continuing concern in healthcare services and could impacts the quality and safety of healthcare. Use of electronic systems has made some aspects of documentation more comprehensive, but creation of an individualized care plan remains a pressing issue.

DESIGN: A qualitative descriptive design was used.

METHODS: An action research project was conducted between 2010 and 2012 to improve the content and quality of nursing documentation in community healthcare services in four municipalities. One year after the project was completed four focus group interviews were conducted with healthcare professionals, one for each involved municipality. Two unit managers were interviewed individually. Qualitative content analysis was used.

RESULTS: Three themes emerged: healthcare professionals perceived competing interest; they experienced that they had to manage complexity and changes; and they highlighted a clear and visible leader as important for success.

CONCLUSIONS: Quality improvement activities are essential. Healthcare professionals experience a complicated situation when electronic health record systems do not support workflow. Further research is recommended to focus on the functionality and user interface of EHR systems, and on the role of leadership when implementing changes in clinical practice. This article is protected by copyright. All rights reserved.

A text analytics evaluation of a first-year engineering project-based unit

In the undergraduate engineering program at Griffith University in Australia, the unit 1006ENG Design and Professional Skills aims to provide an introduction to engineering design and professional practice through a project-based learning (PBL) approach to problem solving. It provides students with an experience of PBL in the first-year of their programme. The unit comprises an underpinning lecture series, design work including group project activities, an individual computer-aided drawing exercise/s and an oral presentation. Griffith University employs a ‘Student Experience of Course’ (SEC) online survey as part of its student evaluation of teaching, quality improvement and staff performance management processes. As well as numerical response scale items, it includes the following two questions inviting open-ended text responses from students: i) What did you find particularly good about this course? and ii) How could this course be improved? The collection of textual data in in student surveys is commonplace, due to the rich descriptions of respondent experiences they can provide at relatively low cost. However, historically these data have been underutilised because they are time consuming to analyse manually, and there has been a lack of automated tools to exploit such data efficiently. Text analytics approaches offer analysis methods that result in visual representations of comment data that highlight key individual themes in these data and the relationships between those themes. We present a text analytics-based evaluation of the SEC open-ended comments received in the first two years of offer of the PBL unit 1006ENG. We discuss the results obtained in detail. The method developed and documented here is a practical and useful approach to analysing/visualising open-ended comment data that could be applied by others with similar comment data sets.

Impact of a modified nursing handover model for improving nursing care and documentation in the emergency department: A pre- and post-implementation study

The aim of this study was to evaluate whether implementation of a new nursing handover model led to improved completion of nursing care activities and documentation. A pre- and post-implementation study, using a survey and document audit, was conducted in a hospital ED in Melbourne. A convenience sample of nurses completed the survey at baseline (n = 67) and post-intervention (n = 59), and the audit was completed at both time points. Results showed significant improvements in several processes: handover in front of the patient (P < 0.001), patients contributed and/or listened to handover discussions (P < 0.001), and provision of adequate information about all patients in the department (P < 0.001). Nurses also reported a reduction in omission of vital signs (P = 0.022) during handover. Three hundred sixty-eight medical records were audited in the two study periods: 173 (pre-intervention) and 195 (post-intervention). Statistically significant improvements in the completion of two nursing care tasks and three documentation items were identified. The findings suggest that implementation of a new handover model improved completion of nursing care activities and documentation, and transfer of important information to nurses on oncoming shifts.

From continuous improvement to organisational learning : developmental theory

As a learning theory, the continuous improvement (CI) discourse has benefited countless manufacturing enterprises to improve and adapt their methods of production. As one of the pillars of total quality management, it has generally included a range of dynamic concepts from high involvement teamwork and production enablers, to other social and technical capabilities such as innovation techniques. Such methodologies have been promoted in the literature as potential manifestos that can transform existing capabilities from simple representations of capability, to dynamically integrated ones (often labelled “full CI capacity”). The latter term in particular deserves more attention in the literature. Since CI techniques cannot be separated from organisational learning methodologies, it follows that CI methods should underpin holistic learning. This paper explores whether CI methodologies have advanced far enough to be considered as integrated and holistic in their own right. If not, it follows that new theories, challenges and discourses should be considered for exploration in the CI literature.

Knowledge management and its links with quality

Knowledge management is a concept that continues to draw a lot of interest. It is the process of sharing knowledge within an organisation to achieve better performance. It can be utilised by all organisations, many of which may not even be aware they are using the concept nor of its links with Quality management. By implementing an effective KM system increased organisational performance and ultimately a competitive advantage can be obtained - both of which correlate to the philosophy of Quality. This paper raises issues about the relationship between the gathering, storing and sharing of knowledge and the philosophy of continuous improvement with the facilitation of teamwork. It concludes by attempting to encourage further debate and research into the area by suggesting that Knowledge Management may be well the 'catalyst' for the resurgence of Quality Management.

Continuous improvement through shared understanding : reconceptualising instructional design for online learning

Many Australian tertiary institutions provide support for academic staff in the design and development of online teaching and learning resources, often employing a centralised unit staffed with educational and instructional designers, multimedia and online developers, audio/video producers and graphic artists. It is not unusual for these units to have evolved from print-based distance education providers and consequently the design and development processes inherent within those units are often steeped in ‘traditional’ sequential instructional development models. We argue that these models are no longer valid for effectively working with academic staff given the dynamic nature of online learning environments and the diversity of skills to implement effective online learning. This paper therefore presents an extended instructional design model in which the development cycle for online teaching and learning materials uses a scaffolding strategy in order to cater for learner-centred activities and to maximise scarce developer and academic resources. The model also integrates accepted phases of the instructional development process to provide guidelines for the disposition of staff and to more accurately reflect the creation of resources as learning design rather than instructional design. It is a model that builds on instructional design processes and integrates concepts of team-based development, shared understanding and the development of relevant communities of practice.

Measuring quality of life in alcohol and other drug users - the need for improvement

Objective : The use of Quality of Life (QoL) -related measures in Alcohol and Other Drug-related research has increased dramatically over the past decade. However, there remains a great deal of confusion about which type of QoL measure is most valid, what each constrict actually measures and the ethicality of the process of QoL measurement and its subsequent transfer to monetary value. This is particularly important in regard to subsequent resource allocation on the basis of Quality Adjusted Life Years (QALYs). We aim to review the logic of current QoL -related measurement and determine the most conceptually valid way of measuring QoL.

Methods : This review considers some of the broad principles that concern quality of life assessment. These are discussed in relation to health-related quality of life (HRQoL) and the measurement of subjective well-being.

Results : We argue that there are serious logical and methodological issues concerning HRQoL measurement, to the extent that the instruments may not be regarded as valid measures of life quality as this term is generally understood.

Conclusions : It is recommended that HRQoL measurement be abandoned in favour of three separate forms of measurement as medical symptoms, subjective well-being and specific dimensions of psychological ill-being.

Towards a more holistic approach to quality improvements in aluminium die casting

This work evaluates the feasibility of using a holistic approach, based on dynamical system theory,
to reduce porosity defects in high pressure aluminum die casting. Quality improvements, from a
dynamical system perspective mean the ability to move the die casting process out of its natural
equilibrium to a more beneficial state and the ability to maintain this new process state. This more beneficial state may be achieved in several ways. One way is to increase the amount of forcing to overcome natural process resistance. This forcing approach is represented by typical continuous intervention policy, with modifications in die/part design and/or process parameters. An alternative approach is to reduce the amount of natural process resistance, in particular the amount of process disturbance, allowing the process to move out of its natural equilibrium with much less forcing. This alternative uses the self-regulating ability of dynamical systems thus decreasing the amount of human intervention required. In this respect, the influence of vacuum on time on chattering at the first stage of the casting shot was identified as a good process candidate for testing using dynamical system theory. A significant reduction in porosity defects was achieved, which also set the process on a path of slow but consistent self-improvement.