Towards solutions for a liveable future: progress, practice, performance, people: Proceedings of the 41st Annual Conference of the Architectural Science Association ANZAScA

There is hope! Since Al Gore disclosed the inconvenient truth, the climate has changed. The time of denial is over; the era of well-informed action and sound development is with us. Sustainability has now moved from the fringe, into the mainstream of politics, society, architecture and building practice. In this new context architectural science will contribute to two main tasks: prevent further damage to our environment, and respond to challenges invoked by climate change.
The built environment and human activity within it account for a large part of the problem. Architectural science and architectural practice are part of the solution. The ANZAScA 2007 conference focuses on the solutions architectural science has to offer toward a liveable future through the following generic themes:
progress – the evaluation and improvement of built facilities, new and existing, in terms of energy intensity, financial reward and environmental impact.
practice – the relationship between our cultural heritage, new facility design, retrofit design and its realisation
through construction.
performance – the connection between building operation targets, validation of performance, and user comfort and interaction in new and existing environments.
people – the effect of space on user behaviour, user responsibility and social wealth.
In response to this challenge, architectural science researchers including students, educators, and practitioners at ANZAScA 2007, present a broad range of research activity and concern within the built environment from global issues down to the specific actions of individuals.

Library learning space design : a good student fit

We are seeing a renewed interest nationally and internationally in the design and development of new learning environments. There is, at Deakin and more generally in the higher education sector, recognition that the students' experience of a flexible and supportive educational environment is central to excellent teaching and fosters student success. Recent Carrick Institute (now the Australian Learning and Teaching Council) grants have supported the need for a greater understanding of good practice, with workshops being held around the country.

The student experience is integral to planning the re-purposing of Library spaces at Deakin's two larger campuses, Waurn Ponds and Burwood. The physical spaces within the Library will be flexible and provide support for individual learning and study, group learning and discussion, with ubiquitous ICT access and assistance services readily accessible. The improvement to the amenities, including contemporary, wired casual spaces, will encourage students to come on to campus and stay, strengthening opportunities to build a learning community. This learning community can extend through opportunities for social networking to students studying online and off-campus.

Library services and spaces will align with the new pedagogical needs of the university, providing holistic support for students' flexible learning experiences.
"We know that space can have a significant impact on teaching and learning . . . What we know about how people learn has changed our ideas about learning space. There is value from bumping into someone and having a casual conversation. There is value from hands on, active learning as well as from discussion and reflection. There is value in being able to receive immediate support when needed and from being able to integrate multiple activities [and multiple information sources] to complete a project." (Diane Oblinger, Learning Spaces, EDUCAUSE, 2006).

The effect of using trained versus untrained adult respondents in simulated practice interviews about child abuse

Objective
A single study tested the hypothesis that simulated practice interviews for investigative interviewers of children are more effective when the role of the child respondent is played by trained actors (i.e., postgraduate psychology students) than untrained fellow participants (i.e., child protection workers).
Method
The interviewers included 50 child protection service workers. Each interviewer received instruction in the use of open-ended questions and then engaged in two simulated practice interviews. The role of the child respondent in the practice interviews was played by either a trained psychology student or an untrained fellow participant. The key outcome measure was the proportion of open-ended questions, which was assessed immediately prior to and after the practice sessions, as well as 12 weeks post-training.
Results
Interviewers who had practiced with trained actors had higher post-training performance (M = .83, SD = .12) compared to those who had practiced with untrained fellow participants (M = .73, SD = .13, p < .05), even at the 12-week follow up (M actors = .66, SD = .25; M untrained actors = .49, SD = .23, p < .05).
Conclusions
Training programs that make better use of practice opportunities (e.g., by using trained respondents) will be more effective in improving the performance of investigative interviewers.
Practice implications
A single study investigated the relative effectiveness of two simulated practice exercises for professionals who interview children about abuse. This research is relevant to professionals who design investigative interviewer training programs because it indicates that practical exercises, which are currently chosen on an ‘ad hoc’ or convenience basis, can vary markedly in their effectiveness in encouraging adherence to open questions.

Designing, implementing and evaluating a social work practice skills course: a case example

Practice skills, such as communication and interviewing skills, are an integral part of every undergraduate course that aims to provide professional qualification for social workers. While there is substantial literature about the skills required to be a proficient social work practitioner, there is a dearth of literature about how to teach such skills and particularly how students experience such a course. By critically reflecting on the design, implementation and evaluation of a social work practice skills course, this article is offered as a contribution toward filling an identified gap in social work education literature. The course evaluation particularly highlights the importance of face to face interaction between students and teachers to the process of learning.

What do general practitioners think depression is? A taxonomy of distress and depression for general practice

Objective:
To create a taxonomy of distress and depression for use in primary care, that mirrors the thinking and practice of experienced general practitioners.

Design:
Qualitative study, using an ethnomethodological approach, with observation of videotaped routine GP–patient consultations and in-depth interviews with GPs.

Setting and participants:
The study was conducted in metropolitan Melbourne in 2005. Fourteen GPs conducted 36 patient consultations where depression was a focus; nine GPs participated in in-depth interviews to elicit details of how they recognised and diagnosed depression in their patients.

Results:
GPs consider distress and depression in three steps. In the first step, a change in a group of symptoms and signs is observed (eg, facial expression, loss of drive). The second step categorises the syndrome according to whether or not there is an identifiable environmental cause (reactive or “endogenous”), with the final step categorising the reactive syndromes according to their most prominent symptoms: either anxiety and worry, or helplessness and hopelessness. The resulting taxonomy includes: endogenous depression (a chronic and perhaps characterological depression characterised by a lack of interest and motivation); anxious depressive reaction (stress or worry); and hopeless depressive reaction (demoralisation).

Conclusion:
This simple and parsimonious taxonomy has validity based on its derivation from within the primary care setting.

Measurement for improvement: a survey of current practice in Australian public hospitals

Objective:
To identify patient safety measurement tools in use in Australian public hospitals and to determine barriers to their use.

Design:
Structured survey, conducted between 4 March and 19 May 2005, designed to identify tools, and to assess current use of, levels of satisfaction with, and barriers to use of tools for measuring the domains and subdomains of: organisational capacity to provide safe health care; patient safety incidents; and clinical performance.

Participants and setting:
Hospital executives, managers and clinicians from a nationwide random sample of Australian public hospitals stratified by state and hospital peer grouping.

Main outcome measures:
Tools used by hospitals within the three domains and their subdomains; patient safety tools and processes identified by individuals at these hospitals; satisfaction with the tools; and barriers to their use.

Results:
Eighty-two of 167 invited hospitals (49%) responded. The survey ascertained a comprehensive list of patient safety measurement tools that are in current use for measuring all patient safety domains. Overall, there was a focus on use of processes rather than quantitative measurement tools. Approximately half the 182 individual respondents from participating hospitals reported satisfaction with existing tools. The main reported barriers were lack of integrated supportive systems, resource constraints and inadequate access to robust measurement tools validated in the Australian context. Measurement of organisational capacity was reported by 50 (61%), of patient safety incidents by 81 (99%) and of clinical performance by 81 (99%).

Conclusion:
Australian public hospitals are measuring the safety of their health care, with some variation in measurement of patient safety domains and their subdomains. Improved access to robust tools may support future standardisation of measurement for improvement.

The effects of a simplified tai-chi exercise program (STEP) on the physical health of older adults living in long-term care facilities : a single group design with multiple time points

Background
Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred.
Objective
To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities.
Design
A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started.
Settings
Two 300–400 bed veteran homes in Taiwan.
Participants
The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded.
Methods
The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization.
Results
A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038).
Conclusions
Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

The Chihuahua sustainability practice: lots of shivering but no real action. Practical sustainability acceptance is low in German and New Zealand firms

Purpose – This paper aims to describe the extent to which corporate organizations in Germany and in New Zealand have included sustainability practices as part of their strategic planning process.

Design/methodology/approach – Current literature is reviewed to make a case for sustainability to be a driver behind corporate decision making and long-term performance. The results of surveys of several hundred firms in both Germany and New Zealand, countries with a publicly stated commitment to sustainability, are reviewed to compare the adoption rates of sustainability practices.

Findings – There is a significant difference between what firms do and what their managers think is important. Managers largely consider sustainability practices an important factor for their future careers, while firms to a large extent do not include sustainability as part of their strategic or operational planning process.

Research limitations/implications – The International Sustainability Acceptance Measurement (ISAM) collects data in several countries through local-language versions of the same online survey tool (www.worldreply.com). The findings in this report are specific only to New Zealand and Germany.

Practical implications – The paper points academics, corporate executives and sustainability fanatics to an alarming inconsistency between what is publicly reported as commitment to sustainability and what is practically achieved.

Originality/value – This paper adds value to the discussion of how sustainability practices have migrated into the operation of firms.

Does an evidence-based sedation protocol improve practice and patient outcomes in critical care?

Learning Objective 1: compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care.

Learning Objective 2: explain the contrasting international research findings on sedation protocol implementation.
Minimization of sedation in critical care patients has recently received widespread support. Professional organizations internationally have published sedation management guidelines for critically ill patients to improve the use of research in practice, decrease practice variability and shorten mechanical ventilation duration. Innovations in practice have included the introduction of decision making protocols, daily sedation interruptions and new drugs and monitoring technologies. The aim of this study was to compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care setting.

A randomized, controlled trial design was used to study 312 mechanically ventilated adult patients in a general critical care unit at an Australian metropolitan teaching hospital. Patients were randomly assigned to receive protocol directed sedation management developed from evidence based guidelines (n=153) or usual clinical practice (n=159).

The median (95% CI) duration of ventilation was 58 hrs (44–78 hrs) for patients in the non-protocol group and 79 hrs (56–93) for those patients in the protocol group (p=0.20). Results were not significant for length of stay in critical care or hospital, the frequency of tracheostomies, and unplanned extubations. A Cox proportional hazards model estimated that protocol directed sedation management was associated with a 22% decrease (95% CI: 40% decrease to 2% increase, p=0.07) in the occurrence of successful weaning from mechanical ventilation.

Few randomized controlled trials have evaluated the effectiveness of protocol-directed sedation outside of North America. This study highlights the lack of transferability between different settings and different models of care. Qualified, high intensity nursing in the Australian critical care setting facilitates rapid, responsive decisions for sedation management and an increased success rate for weaning from mechanical ventilation.

Design-related bias in hospital fall risk screening tool predictive accuracy evaluations: systematic review and meta-analysis.

Introduction: Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals. Design-related bias in evaluations of tool predictive accuracy could lead to overoptimistic results, which would then contribute to program failure in practice.

Methods: A systematic review was undertaken. Two blind reviewers assessed the methodology of relevant publications into a four-point classification system adapted from multiple sources. The association between study design classification and reported results was examined using linear regression with clustering based on screening tool and robust variance estimates with point estimates of Youden Index (= sensitivity + specificity - 1) as the dependent variable. Meta-analysis was then performed pooling data from prospective studies.

Results: Thirty-five publications met inclusion criteria, containing 51 evaluations of fall risk screening tools. Twenty evaluations were classified as retrospective validation evaluations, 11 as prospective (temporal) validation evaluations, and 20 as prospective (external) validation evaluations. Retrospective evaluations had significantly higher Youden Indices (point estimate [95% confidence interval]: 0.22 [0.11, 0.33]). Pooled Youden Indices from prospective evaluations demonstrated the STRATIFY, Morse Falls Scale, and nursing staff clinical judgment to have comparable accuracy.

Discussion: Practitioners should exercise caution in comparing validity of fall risk assessment tools where the evaluation has been limited to retrospective classifications of methodology. Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular settings, but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment.

Rationale, restrictions and responses : online academic development to promote a community of practice

Casual academics play a major role in higher education in Australia today. In their roles as tutors, demonstrators and markers, casual academics need access to opportunities to develop as teachers. As such, Deakin University has developed an online academic development program designed to better equip new and inexperienced casual academics for their roles. This paper reports on the approach that has been taken to designing one module of an online academic development program for casual academics, considering the influence of information and communication technology (ICT) on this design, and discusses an analysis of the feedback on the module by the participants who completed it. A conclusion is drawn that aligning self paced online learning with induction into a community of practice via ICT presents particular challenges.

A new environmental design : sustainable place making in postcolonial Australia

This paper seeks to expand on environmental design understood in purely
instrumentalist terms. It argues that current environmental emergencies in Austlalia and elsewhere are requiring alternative strategies of response, and proposes the terrain of poetic w'ork as offering new insights in the field of sustainability practice. lt draws upon two place-making projects to advance a theory of environmental design that is poetically guided.

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.

The role of cultural capital towards the development of a sustainable business model for design firm internationalization

This paper reports the results of three case studies of firms involved with design for the built environment who have been working in international markets for more than two decades. The first two firms are architectural practices and the third is a construction firm which designs and constructs. Their markets are diverse and their strategies have evolved over the two decades. There are numerous differences between countries including cultural, social, project governance structures, regulatory, procurement strategies, terminology, codes, etc. What is it that makes these firms able to develop sustainable business models in internationalisation? A grounded theory approach was used to examine the three case studies and develop a reflexive capability model drawing from the sociological theory of reflexivity to interpret the characteristics of the firms' ability to be able to adapt different international conditions. Twenty-two interviews were conducted across the three firms. Results indicated that sustainable business models rely upon the management of social, cultural and intellectual capital. The strategic management of capital leads to the development of increasing reflexive capability within the processes related to internationalisation. Reflexive capability is a characteristic of the three successful case study firms internationalising and working within global models of practice. This paper focuses on the role of cultural capital in a reflexive capability model for sustainable internationalisation.