Decision-making models used by `graduate nurses` managing patients` medications

Background. Nurses in a graduate programme in Australia are those who are in the first year of clinical practice following completion of a 3-year undergraduate nursing degree. When working in an acute care setting, they need to make complex and ever-changing decisions about patients' medications in a clinical environment affected by multifaceted, contextual issues. It is important that comprehensive information about graduate nurses' decision-making processes and the contextual influences affecting these processes are obtained in order to prepare them to meet patients' needs.
Aim. The purpose of this paper is to report a study that sought to answer the following questions: What are the barriers that impede graduate nurses' clinical judgement in their medication management activities? How do contextual issues impact on graduate nurses' medication management activities? The decision-making models considered were: hypothetico-deductive reasoning, pattern recognition and intuition.
Methods. Twelve graduate nurses who were involved in direct patient care in medical and surgical wards of a metropolitan teaching hospital located in Melbourne, Australia participated in the study. Participant observations were conducted with the graduate nurses during a 2-hour period during the times when medications were being administered to patients. Graduate nurses were also interviewed to elicit further information about how they made decisions about patients' medications.
Results. The most common model used was hypothetico-deductive reasoning, followed by pattern recognition and then intuition. The study showed that graduate nurses had a good understanding of how physical assessment affected whether medications should be administered or not. When negotiating treatment options, graduate nurses readily consulted with more experienced nursing colleagues and doctors.
Study limitations. It is possible that graduate nurses demonstrated a raised awareness of managing patients' medications as a consequence of being observed.
Conclusions. The complexity of the clinical practice setting means that graduate nurses need to adapt rapidly to make sound and appropriate decisions about patient care.

How graduate nurses use protocols to manage patients` medications

Aims and objectives. The aim of the study was to determine how graduate nurses use protocols in their medication management activities. The objectives were to: examine the extent of adherence to various protocols in relation to medication activities and determine how the ward environment impacts on graduate nurses' use of protocols to manage patients' medications.
Background. Protocols help newly qualified nurses integrate new knowledge into practice and promote effective decision-making
Design. A descriptive prospective qualitative design was used.
Methods. Twelve graduate nurses involved in direct patient care in medical, surgical and specialty wards of a metropolitan teaching hospital participated in the study. Participant observations were conducted with the graduate nurses during a two-hour period when medications were being administered to patients. In-depth interviews were conducted with each nurse immediately after observations and demographic data were collected on participating nurses and patients in their care, including all medications prescribed. Protocols associated with medication management activities for the clinical settings were also transcribed.
Results. Six themes were evident from the data: availability and use of protocols, scrutinizing patients' identity before medication administration, double-checking certain medications before administration, writing incident reports, following specific policies and timing the administration of medications.
Conclusion. Graduate nurses adhered to protocols if they were perceived not to impede with other nursing activities. Participants were also more likely to follow protocols if they felt encouraged to make their own decisions and if there was a decreased likelihood that disciplinary action would be involved.
Relevance to clinical practice. Experienced health professionals should encourage graduate nurses to comply with medication protocols and to make clinically reasoned decisions about medication activities. By providing peer support and acting as role models, experienced health professionals can also demonstrate to graduate nurses how effective protocol use is an important component of quality patient care.

Integration and multiculturalism in music in Australian schools: has/can/should the leopard change its spots?

The 1960s saw a broadening of the offerings of music from other cultures in the materials and programs of the Australian Broadcasting Commission (ABC). This is a useful indicator for our changing perceptions. Since then, increasingly ‘authentic’ music materials have been available to primary classroom teachers, but how far have we really come? Blacking (1973) identified the difficulty of truly acquiring an understanding, skill and authenticity in the music of another culture. Blacking stressed the importance of music and musical acquisition occurring in a cultural context. In many cultures there is a clear link between the acquisition of musical and social skills. By removing music from one culture and presenting it in the symbolic gestures of another we may strip much of its meaning. It is very difficult for a member of one culture to comprehend the music and culture of another without understanding its social milieu. This is particularly true for musics from cultures removed from the Western music paradigm. It could be argued that the further we move from our cultural norm, the harder it is to produce authentic experiences for students and future experienced teachers. By considering the resources offered to teachers and teacher education students we can explore the attempts we have made, and continue to make, in our attempts to move from integration to multiculturalism. As a ‘work in progress’, this paper will consider the inclusion of African music in the nationally distributed ABC school singing books as a means of illustrating and marking change.

Youth and sexualities : pleasure, subversion and insubordination in and out of schools

These cutting-edge international essays challenge dominant narratives of queer youth predicated on oppression and victimization. As school systems address the emergence of Gay-Straight Alliances and calls to provide equal educational access, researchers, educators and youth workers are paying increasing attention to sexuality, gender and schooling. Yet present discourses are limited to liberal understandings of tolerance, safety, and equity that are defined by a separation of "queer" and "normal." This text documents and offers radical interpretations of the creativity of queer youth in challenging existing practices. Interdisciplinary analyses offer multiple vantage points for reconceptualizing adolescent sexual subjectivities and institutional and cultural practices.

Health promotion and health education in schools : trends, effectiveness and possibilities

This report involved an extensive literature review as well as discussions with ten leading school health and traffic safety education researchers and practitioners. The findings of the report show that despite health promotion and health education activities occurring in all Victorian schools, school health related initiatives could be improved by focusing on cognitive outcomes and involving appropriate components of Health Promoting School (HPS) framework. Providing teachers with professional development and utilising interactive resources that complement the curriculum is also important. The report recommendations outline ways to improve the Health Promotion and Health Education and provide a potential framework for delivering TSE provision in schools.

Using ICT to support literacy and numeracy in rural schools

This project grew directly from the SiMERR national forum of 2003 and involved a partnership between SiMERR Victoria and the Association of Independent Schools of Victoria to evaluate a PD model for rural independent schools. The initiative was that of AISV and the Deakin team conducted a formative and summative evaluation.

A snapshot of SOSE in Victorian schools, 2003

Presents a study on teaching Studies of Society and Environment (SOSE) in secondary schools in Victoria. Socio-demographic characteristics of SOSE teachers; Curriculum analysis; Attitudes of teachers and students toward SOSE; Challenges being faced by SOSE teachers; Implications of SOSE on Victorian education.