Key behavioural and cognitive employee outcomes : a social exchange model

This paper serves to integrate social exchange with organisational justice and performance theory. Social exchange relationships are represented by employees’ perceptions of workplace inequity and evaluated using justice rules. Employees are expected to have in-role and extra-role behavioural responses and cognitive responses to inequity. It is theorised that behavioural and cognitive responses are moderated by the employee’s perceptions of organisational justice. Much employee performance, commitment, engagement, retention and turnover may be explained by this comprehensive model.

Gender differences in organizational justice predicting the key employee outcomes of organizational commitment, job satisfaction and turnover intention

All four types of organizational justice – distributive, procedural, interpersonal and informational – were included in this study of gender differences. Both male and female respondents perceived the distributive-procedural justice and interpersonal-informational justice pairings similarly and weakly. Females consistently discriminated more clearly across the pairings, however. The effect of the four justices was also found to be gender-dependent. Males’ perception of distributive justice directly predicted their turnover intentions and commitment to the organization, while females’ perception of distributive justice predicted only job satisfaction. Males’ perceptions of procedural and information justice both predicted job satisfaction. Females’ informational justice perceptions predicted job satisfaction and commitment to the organization. The paper contributes to the literature by presenting results from all four justice types and the simultaneous use of the three outcomes of job satisfaction, organizational commitment and intention to quit. Overall, the males had a diffuse set of relationships between the justice types and the outcomes, whereas the relationships between the justice types and
the outcomes for females tended more to follow a limited number of pathways. The study was validated with data collected on two separate occasions.

Role of blended cultures in enhancing teacher and learner performance outcomes

This paper explores the enhancement of teaching and learning perfonnance outcomes from the perspective of educators from different cultural backgrounds and a very large mix of international students. The research milieu focuses on social connectivity, peer-ta-peer networking and peer-ta-peer meDtaring amongst teachers, tutors and students; particularly aspects of trust and cultural awareness between teacher and learner.  The key findings of this research are that the social capital dimensions of trust and reciprocity, and the notion of academic guanxi can assist academics and institutions to better understand ways in which to optimize teaching and learning. The result is a pool of educators who have become change-agents by inspiring a network of their peers in using components of a collective cultural toolkit as a culture reference point.

Psychic distance : antecedents, retail strategy implications and performance outcomes

The authors propose a conceptual model of the psychic distance–organizational performance relationship that incorporates organizational factors (international experience and centralization of decision making), entry strategy, and retail strategy implications. The findings suggest that when entering psychically distant markets, retailers should adopt low-cost/low-control entry strategies and adapt their retail strategy to a greater extent than in psychically close markets. However, the authors find that such strategic responses have an adverse effect on performance. They find that international experience, psychic distance, entry strategy, and retail strategy adaptation are significant drivers of organizational performance and factors that determine critical success in international retailing.

Discrimination of educational outcomes between differing levels of critical care programmes by selected

Objective: This study was designed to prioritise educational outcomes for three levels of postgraduate speciality critical care nursing programmes.

Background: Postgraduate speciality education has proliferated within Australia over the past 20 years. However, there is little agreement regarding the expected characteristics, or relevant priorities, of these characteristics of graduates successfully completing these programmes of study.

Method: This study used a mixed-method approach comprising two phases. Initially a survey was mailed to volunteers between March and June 2005 to obtain priorities in educational outcomes for graduates of critical care programmes. This was followed by a stakeholder focus group in May 2006 to refine expected outcomes.

Results: Survey respondents rated educational outcomes that described professional and legal aspects of practice to ensure safe patient care as highest priority for programme graduates. Although most educational outcome statements were considered important for graduates from all levels of courses, increasing levels of practice was described for increasingly higher levels of programmes from Graduate Certificate to Masters Degree.

Conclusion: This study provides an emerging description of the priorities of critical care nursing programmes, with priority given to professional and legal aspects of practice. Further delineation of priorities is necessary to inform ongoing educational development.

Enhancing the health of medical students : outcomes of an integrated mindfulness and lifestyle program

Medical students experience various stresses and many poor health behaviours. Previous studies consistently show that student wellbeing is at its lowest pre-exam. Little core-curriculum is traditionally dedicated to providing self-care skills for medical students. This paper describes the development, implementation and outcomes of the Health Enhancement Program (HEP) at Monash University. It comprises mindfulness and ESSENCE lifestyle programs, is experientially-based, and integrates with biomedical sciences, clinical skills and assessment. This study measured the program’s impact on medical student psychological distress and quality of life. A cohort study performed on the 2006 first-year intake measured effects of the HEP on various markers of wellbeing. Instruments used were the depression, anxiety and hostility subscales of the Symptom Checklist-90-R incorporating the Global Severity Index (GSI) and the WHO Quality of Life (WHOQOL) questionnaire. Pre-course data (T1) was gathered mid-semester and post-course data (T2) corresponded with pre-exam week. To examine differences between T1 and T2 repeated measures ANOVA was used for the GSI and two separate repeated measures MANOVAs were used to examine changes in the subscales of the SCL-90-R and the WHOQOL-BREF. Follow-up t-tests were conducted to examine differences between individual subscales. A total of 148 of an eligible 270 students returned data at T1 and T2 giving a response rate of 55%. 90.5% of students reported personally applying the mindfulness practices. Improved student wellbeing was noted on all measures and reached statistical significance for the depression (mean T1 = 0.91, T2 = 0.78; p = 0.01) and hostility (0.62, 0.49; 0.03) subscales and the GSI (0.73, 0.64; 0.02) of the SCL-90, but not the anxiety subscale (0.62, 0.54; 0.11). Statistically significant results were also found for the psychological domain (62.42, 65.62; p < 0.001) but not the physical domain (69.11, 70.90; p = 0.07) of the WHOQOL. This study is the first to demonstrate an overall improvement in medical student wellbeing during the pre-exam period suggesting that the common decline in wellbeing is avoidable. Although the findings of this study indicate the potential for improving student wellbeing at the same time as meeting important learning objectives, the limitations in study design due to the current duration of follow-up and lack of a control group means that the data should be interpreted with caution. Future research should be directed at determining the contribution of individual program components, long-term outcomes, and impacts on future attitudes and clinical practice.

Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children : switch-play

Objectives : To evaluate the effectiveness of an intervention to prevent excess weight gain, reduce time spent in screen behaviours, promote participation in and enjoyment of physical activity (PA), and improve fundamental movement skills among children.

Participants : In 2002, 311 children (78% response; 49% boys), average age 10 years 8 months, were recruited from three government schools in low socioeconomic areas of Melbourne, Australia.

Design : Group-randomized controlled trial. Children were randomized by class to one of the four conditions: a behavioural modification group (BM; n=66); a fundamental movement skills group (FMS; n=74); a combined BM/FMS group (BM/FMS; n=93); and a control (usual curriculum) group (n=62). Data were collected at baseline, post intervention, 6- and 12-month follow-up periods.

Results : BMI data were available for 295 children at baseline and 268 at 12-month follow-up. After adjusting for food intake and PA, there was a significant intervention effect from baseline to post intervention on age- and sex-adjusted BMI in the BM/FMS group compared with controls (-1.88 kg m-2, P<0.01), which was maintained at 6- and 12-month follow-up periods (-1.53 kg m-2, P<0.05). Children in the BM/FMS group were less likely than controls to be overweight/obese between baseline and post intervention (adjusted odds ratio (AOR)=0.36, P<0.05); also maintained at 12-month follow-up (AOR=0.38, P<0.05). Compared with controls, FMS group children recorded higher levels and greater enjoyment of PA; and BM children recorded higher levels of PA and TV viewing across all four time points. Gender moderated the intervention effects for participation in and enjoyment of PA, and fundamental movement skills.

Conclusion : This programme represents a promising approach to preventing excess weight gain and promoting participation in and enjoyment of PA. Examination of the mediators of this intervention and further tailoring of the programme to suit both genders is required.

Therapist-assisted, internet-based treatment for panic disorder: can general practitioners achieve comparable patient outcomes to psychologists

Background: Mental illness is an escalating concern worldwide. The management of disorders such as anxiety and depression largely falls to family doctors or general practitioners (GPs). However, GPs are often too time constrained and may lack the necessary training to adequately manage the needs of such patients. Evidence-based Internet interventions represent a potentially valuable resource to reduce the burden of care and the cost of managing mental health disorders within primary care settings and, at the same time, improve patient outcomes.
Objective: The present study sought to extend the efficacy of a therapist-assisted Internet treatment program for panic disorder, Panic Online, by determining whether comparable outcomes could be achieved and maintained when Panic Online was supported by either GPs or psychologists.
Methods: Via a natural groups design, 96 people with a primary diagnosis of panic disorder (with or without agoraphobia) completed the Panic Online program over 12 weeks with the therapeutic assistance of their GP (n = 53), who had received specialist training in cognitive behavioral therapy, or a clinical psychologist (n = 43). Participants completed a clinical diagnostic telephone interview, conducted by a psychologist, and a set of online questionnaires to assess panic-related symptoms at three time periods (pretreatment, posttreatment, and 6 month follow-up).
Results: Both treatments led to clinically significant improvements on measures of panic and panic-related symptomatology from pretreatment to posttreatment. Both groups were shown to significantly improve over time. Improvements for both groups were maintained at follow-up; however, the groups did differ significantly on two quality of life domains: physical (F₁,₈₂ = 9.13, P = .00) and environmental (F₁,₈₂ = 4.41, P = .04). The attrition rate was significantly higher among those being treated by their GP (χ²₁ = 4.40, P = .02, N = 96).
Conclusions: This study provides evidence that Internet-based interventions are an effective adjunct to existing mental health care systems. Consequently, this may facilitate and enhance the delivery of evidence-based mental health treatments to increasingly large segments of the population via primary care systems and through suitably trained health professionals.

Improving outcomes-based engineering education in Australia

Graduate attributes are now a ubiquitous feature of higher education in Australia and internationally, and have been part of engineering education for more than a decade. The idea of graduate attributes is an apparently simple concept, focusing on educational outcomes, rather than inputs and process. While there is evidence of some benefits in engineering education arising from the introduction of outcomes-based accreditation, there is also evidence of many short-comings of the graduate attributes approach. There would be significant value in Engineers Australia providing additional discipline-specific guidance on attribute development. There would be significant value in Engineers Australia simplifying and consolidating the current multi-document accreditation system. A genuinely outcomes-based accreditation system would be based (only) on the demonstrated individual student attainment of appropriate graduate attributes, which might be delivered/gained by a range of means, including distance education. To fully meet the letter and spirit of the law for accreditation, programs will need to adopt some method of certification of individual student attainment of graduate attributes - one such method would be the use of student portfolios.

Fit for intended use : a manufacturing metaphor applied to international business students and learning outcomes

It is no secret that contemporary tertiary education in Australia is significantly reliant on international student fee income in a competitive market. Accordingly, the need to attract fee paying students involves strategies for increasing competitive advantage, new course structures, flexible learning initiatives and marketing. However Jackling (1) has found that employers are reluctant to employ graduate international students in the accounting field as they consider them to lack the skills required to effectively meet employment needs. This paper seeks to focus the spotlight on the role of academics/universities in ensuring that graduates have the skills necessary for employment as part of the education process.

The effectiveness of nutrition interventions on dietary outcomes by relative social disadvantage : a systematic review

Objective: To determine whether nutrition interventions widen dietary inequalities across socioeconomic status groups.

Design: Systematic review of interventions that aim to promote healthy eating.

Data sources: CINAHL and MEDLINE were searched between 1990 and 2007.

Review methods: Studies were included if they were randomised controlled trials or concurrent controlled trials of interventions to promote healthy eating delivered at a group level to low socioeconomic status groups or studies where it was possible to disaggregate data by socioeconomic status.

Results: Six studies met the inclusion criteria. Four were set in educational setting (three elementary schools, one vocational training). The first found greater increases in fruit and vegetable consumption in children from high-income families after 1 year (mean difference 2.4 portions per day, p<0.0001) than in children in low-income families (mean difference 1.3 portions per day, p<0.0003). The second did not report effect sizes but reported the nutrition intervention to be less effective in disadvantaged areas (p<0.01). The third found that 24-h fruit juice and vegetable consumption increased more in children born outside the Netherlands ("non-native") after a nutrition intervention (beta coefficient = 1.30, p<0.01) than in "native" children (beta coefficient = 0.24, p<0.05). The vocational training study found that the group with better educated participants achieved 34% of dietary goals compared with the group who had more non-US born and non-English speakers, which achieved 60% of dietary goals. Two studies were conducted in primary care settings. The first found that, as a result of the intervention, the difference in consumption of added fat between the intervention and the control group was –8.9 g/day for blacks and –12.0 g/day for whites (p<0.05). In the second study, there was greater attrition among the ethnic minority participants than among the white participants (p<0.04).

Conclusions: Nutrition interventions have differential effects by socioeconomic status, although in this review we found only limited evidence that nutrition interventions widen dietary inequalities. Due to small numbers of included studies, the possibility that nutrition interventions widen inequalities cannot be excluded. This needs to be considered when formulating public health policy.

The learning outcomes of an online reflective journal in engineering

Reflective thinking based on experiential learning is a key skill required for the lifelong learner and the socially mature professional. Following several semesters employing a written reflective journal as an assessable task, a fourth-year engineering management unit adopted an online reflective journal. During the initial semester of use, an evaluation was undertaken to investigate student perceptions of the online journal. A summary of this previous work is presented here. Following three semesters of use of the online journal, an analysis of the student use of the journal was undertaken to investigate its contribution to unit learning outcomes. Based on the evaluation of student perceptions of the online reflective journal, it was found that a majority of students understood the purpose of the journal, and valued the journal in their learning; a majority of students read the journal entries of other students, and indicated that this assisted their learning; and the two most frequently reported ‘most useful’ aspects of the journal were the ‘enforced’ continuous revision of course material, and the ability to compare their understanding of the course material with that of other students. Based on a regression analysis of the factors related to student usage of the online reflective journal, it was found that the significant contributors to final unit mark where: prior academic performance; number of journal postings; and mode of study. This research confirmed that the online reflective journal was fertile territory in the landscape of educational technology, both in terms of student perceptions and contribution to unit learning outcomes.

Ambulance call triage outcomes for patients reporting pain : a retrospective cross-sectional analysis of pain score versus traige level

Objective: To identify any association between the response priority code generated during calls to the ambulance communication centre and patient reports of pain severity.

Methods: A retrospective analysis of patient care records was undertaken for all patients transported by paramedics over a 7-day period. The primary research interest was the association between the response code allocated at the time of telephone triage and the initial pain severity score recorded using a numeric rating scale (NRS). Univariate and multivariate logistic regression methods were used to analyse the association between the response priority variable and explanatory variables.

Results: There were 1246 cases in which both an initial pain score using the NRS and a response code were recorded. Of these cases, 716/1246 (57.5%) were associated with a code 1 ("time-critical") response. After adjusting for gender, age, cause of pain and duration of pain, a multivariate logistic regression analysis found no significant change in the odds of a patient in pain receiving a time-critical response compared with patients who had no pain, regardless of their initial pain score (NRS 1–3, odds ratio (OR) 1.11, 95% CI 0.7 to 1.8; NRS 4–7, OR 1.12, 95% CI 0.7 to 1.8; NRS 8–10, OR 0.84, 95% CI 0.5 to 1.4).

Conclusion: The severity of pain experienced by the patient appeared to have no influence on the priority (urgency) of the dispatch response. Triage systems used to prioritise ambulance calls and decide the urgency of response or type of referral options should consider pain severity to facilitate timely and humane care.

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.