Improving renal patient care without compromising safety: interactive simulated e-learning

The nephrology educators network [NEN] recognised in 2007 that inequities existed in the access and delivery of evidence based renal education programs particularly to nurses in regional and remote areas. To address this, a web-based approach to learning, through the development of peer reviewed, interactive nephrology e-learning programs was adopted. These programs aligned with the tenets of e-learning instructional design and afforded more effective and consistent clinical support and induction for nurses in the renal specialty. The e-learning programs promote a standardised evidence-based approach to nephrology education and were developed by content experts from across Australia and New Zealand. The design methodology avoided the duplication of resources while also encouraging knowledge transfer between participating health organisations.

This paper will discuss the development and successful implementation of these e-learning programs across renal healthcare units in Australasia. Implemented packages include: Introduction to Buttonhole Cannulation – featuring an interactive ultrasound and cannulation application; Introduction to Haemodialysis; Introduction to Peritoneal Dialysis [PD], featuring simulated PD machines, allowing for the teaching of troubleshooting without compromising patient safety. E-learning programs are further supported through interactive case scenarios that present unfolding real world simulations and enable learners to meet different patients and manage their care while learning about key messages relating to renal health. Modules currently in development include; Acute Kidney Injury; Fluid Assessment, Water Quality and Vascular Access. The implementation of these programs assist the facilitation of positive change in teaching and learning practices in nephrology nursing aimed at improving patient outcomes.

Reducing intoxication among bar patrons: some lessons from prevention of drinking and driving

Intoxication in and around licensed premises continues to be common, despite widespread training in the responsible service of alcohol and laws prohibiting service to intoxicated individuals. However, research suggests that training and the existence of laws are unlikely to have an impact on intoxication without enforcement, and evidence from a number of countries indicates that laws prohibiting service to intoxicated individuals are rarely enforced. Enforcement is currently hampered by the lack of a standardized validated measure for defining intoxication clearly, a systematic approach to enforcement and the political will to address intoxication. We argue that adoption of key principles from successful interventions to prevent driving while intoxicated could be used to develop a model of consistent and sustainable enforcement. These principles include: applying validated and widely accepted criteria for defining when a person is ‘intoxicated’; adopting a structure of enforceable consequences for violations; implementing procedures of unbiased enforcement; using publicity to ensure that there is a perceived high risk of being caught and punished; and developing the political will to support ongoing enforcement. Research can play a critical role in this process by: developing and validating criteria for defining intoxication based on observable behaviour; documenting the harms arising from intoxication, including risk curves associated with different levels of intoxication; estimating the policing, medical and social costs from intoxicated bar patrons; and conducting studies of the cost-effectiveness of different interventions to reduce intoxication.

Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study

Objectives
This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients.

Design
Mixed-method multi-centre study.

Setting
High fidelity simulated acute clinical environment in three Australian universities.

Participants
A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study.

Method
In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance.

Results
Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p = .034), overall situation awareness (p = .05) and clinical performance in two of the three scenarios (p = .032 cardiac and p = .006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%.

Conclusions
Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.

Driving down daily step counts: the impact of being driven to school on physical activity and sedentary behavior

This study investigated whether being driven to school was associated with lower weekday and weekend step counts, less active out-of-school leisure pursuits, and more sedentary behavior. Boys aged 10–13 years (n = 384) and girls aged 9–13 years (n = 500) attending 25 Australian primary schools wore a pedometer and completed a travel diary for one week. Parents and children completed surveys capturing leisure activity, screen time, and sociodemographics. Commute distance was objectively measured. Car travel was the most frequent mode of school transportation (boys: 51%, girls: 58%). After adjustment (sociodemographics, commute distance, and school clustering) children who were driven recorded fewer weekday steps than those who walked (girls: –1,393 steps p < .001, boys: –1,569 steps, p = .009) and participated in fewer active leisure activities (girls only: p = .043). There were no differences in weekend steps or screen time. Being driven to and from school is associated with less weekday pedometer-determined physical activity in 9- to 13-year-old elementary-school children. Encouraging children, especially girls, to walk to and from school (even for part of the way for those living further distances) could protect the health and well-being of those children who are insufficiently active.

Regulation of motor vehicle advertising: toward a framework for compliance research

There is concern that certain content within some motor vehicle television advertising may negatively influence the driving attitudes and behaviours of viewers, particularly young people, and hence have a negative impact on road safety. In recognition of this concern, many developed countries have adopted a self-regulatory approach to motor vehicle advertising. The basic elements of self-regulation are a code of practice or guiding principles governing advertising content and the establishment of a process for hearing and adjudicating complaints about alleged breaches of that code. However, as in other areas, the effectiveness of self-regulation is being questioned in that many motor vehicle advertisements in Australia and elsewhere appear non-compliant with self-regulatory codes. Applying lessons from studies of alcohol advertising, this paper first reviews the research assessing the content of motor vehicle advertising. A suggested research framework is then proposed to inform the development of motor vehicle advertising regulatory codes where they do not exist, and to better monitor compliance with codes where they do exist. The research framework suggested includes expert content analysis of ads, the impact of advertising on risk-taking cognitions and decisions in computer-simulated traffic situations, and assessing audience perceptions of, and reactions to, messages in advertisements mapped against regulatory code content. An example of audience reaction research is also presented.

Evaluating the corrosion behaviour of magnesium alloy in simulated biological fluid by using SECM to detect hydrogen evolution

Scanning electrochemical microscopy (SECM) in surface generation/tip collection mode is investigated as an assessment tool for studying the corrosion behaviour of magnesium in simulated biological fluid. The technique provides a local map of hydrogen (H2) evolution which alone can be used as a direct measure of corrosion. The H2 generated during corrosion of magnesium is oxidized at the probe(i.e. a Pt ultra micro-electrode);with the magnitude of the current generated due to oxidation being indicative of the intensity of H2 evolution at a local scale on the magnesium surface. This method was calibrated using a cathodically polarized Pt disk to simulate H2 evolution in a controlled condition on a homogeneous surface. Potential interference from dissolving Mg or high local pH was also investigated. The technique was implemented for studying H2 evolution at the surface of AZ31 as a model Mg alloy.SECM results combined with SEM-EDX and profilometry data revealed that local domains of higher H2 evolution on the surface of AZ31 are in close proximityof the observed pitting sites.

Sleep restriction during simulated wildfire suppression: effect on physical task performance

OBJECTIVES: To examine the effects of sleep restriction on firefighters' physical task performance during simulated wildfire suppression. METHODS: Thirty-five firefighters were matched and randomly allocated to either a control condition (8-hour sleep opportunity, n = 18) or a sleep restricted condition (4-hour sleep opportunity, n = 17). Performance on physical work tasks was evaluated across three days. In addition, heart rate, core temperature, and worker activity were measured continuously. Rate of perceived and exertion and effort sensation were evaluated during the physical work periods. RESULTS: There were no differences between the sleep-restricted and control groups in firefighters' task performance, heart rate, core temperature, or perceptual responses during self-paced simulated firefighting work tasks. However, the sleep-restricted group were less active during periods of non-physical work compared to the control group. CONCLUSIONS: Under self-paced work conditions, 4 h of sleep restriction did not adversely affect firefighters' performance on physical work tasks. However, the sleep-restricted group were less physically active throughout the simulation. This may indicate that sleep-restricted participants adapted their behaviour to conserve effort during rest periods, to subsequently ensure they were able to maintain performance during the firefighter work tasks. This work contributes new knowledge to inform fire agencies of firefighters' operational capabilities when their sleep is restricted during multi-day wildfire events. The work also highlights the need for further research to explore how sleep restriction affects physical performance during tasks of varying duration, intensity, and complexity.

River flows and profit flows: the powerful logic driving local news

The importance of local news is gaining traction with industry and in journalism scholarship. But there is a need for careful analysis of what it means to be “local” and how we might theorise the role and place of news organisations and journalists who serve local audiences. This paper draws on three qualitative case studies of local newspapers serving small towns and cities in Australia to generate concepts that can be used to deepen understanding about this form of news. Our research highlights that to be local is practical and embodied. It requires individuals, groups, organisations or institution to be anchored in a particular locale and have in-depth understanding of that place that has developed over time. We extend the scholarship of Pierre Bourdieu to suggest this may be understood as local habitus—a powerful set of dispositions and practical logic developed within a place—that the small newspaper is inherently tied to. Reading a newspaper is part of one's local habitus while an individual who possesses it in the journalistic field may have a significant advantage in their day-to-day practices. We suggest this theoretical lens can offer rich insights into the future of local news production across the western world.

What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients.

To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients.

Leadership and teamwork in medical emergencies: performance of nursing students and registered nurses in simulated patient scenarios

Aims and objectives: To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients. Background: Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience. Design: Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia. Methods: Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Results: Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p < 0·01). In both groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p < 0·01) and hypovolaemia scenario (student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support. Conclusions: There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills. Relevance to clinical practice: There is a need to encourage less experienced staff to become leaders and for all staff to develop improved teamwork skills for medical emergencies. © 2014 John Wiley & Sons Ltd.

Situation awareness in undergraduate nursing students managing simulated patient deterioration

Nursing work often occurs in complex and potentially hazardous settings. Awareness of patient and practice environments is an imperative for nurses in practice.

The effect of simulated thermomechanical processing on the transformation behavior and microstructure of a low-carbon Mo-Nb linepipe steel

The present work investigates the transformation behavior of a low-carbon Mo-Nb linepipe steel and the corresponding transformation product microstructures using deformation dilatometry. The continuous cooling transformation (CCT) diagrams have been constructed for both the fully recrystallized austenite and that deformed in uniaxial compression at 1148 K (875 °C) to a strain of 0.5 for cooling rates ranging from 0.1 to about 100 K/s. The obtained microstructures have been studied in detail using electron backscattered diffraction complemented by transmission electron microscopy. Heavy deformation of the parent austenite has caused a significant expansion of the polygonal ferrite transformation field in the CCT diagram, as well as a shift in the non-equilibrium ferrite transformation fields toward higher cooling rates. Furthermore, the austenite deformation has resulted in a pronounced refinement in both the effective grain (sheaf/packet) size and substructure unit size of the non-equilibrium ferrite microstructures. The optimum microstructure expected to display an excellent balance between strength and toughness is a mix of quasi-polygonal ferrite and granular bainite (often termed “acicular ferrite”) produced from the heavily deformed austenite within a processing window covering the cooling rates from about 10 to about 100 K/s.