Triage nurses' clinical decision making : an observational study of urgency assessment

Background. Researchers have described both the various decision tasks performed by triage nurses using self-report methods and identified time as a factor influencing the quality of triage decisions. However, little is known about the decision tasks performed by triage nurses when making acuity assessments, or the factors influencing triage duration in the real world.

Aims. The aims of this study were to: describe the data triage nurses collect from patients in order to allocate a triage priority using the Australasian Triage Scale (ATS); describe the duration of nurses' decision making for ATS categories 2–5; and to explore the impact of patient and nurse variables on the duration of the triage nurses' decision making in the clinical setting.

Design. A structured observational study was employed to address the research aims. Observational data was collected in one adult emergency department located in metropolitan Melbourne, Australia. A total of 26 triage nurses consented and were observed performing 404 occasions of triage. Data was collected by a single observer using a 20-item instrument that recorded the performance frequencies of a range of decision tasks and a number of observable patient, nurse and environmental variables. Additionally, the nurse–patient interaction was recorded as time in minutes.

Results. It was found that there was limited use of objective physiological data collected by the nurses' in order to decide patient acuity, and large variability in the duration of triage decisions observed. In addition, analysis of variance indicated strong evidence of a true difference between triage duration and a range of nurse, patient and environmental variables.

Conclusion. These findings have implications for the development of practice standards and triage education. In particular, it is argued that practice standards should include routine measurement of physiological parameters in all but the collapsed or obviously unwell patient, where further delay may impede the delivery oftime-critical intervention. Furthermore, the inclusion of arbitrary time frames for triage assessment in practice standards are not an appropriate method of evaluating triage decision making in the real world.

Teamwork and assessment: a critique

Australian universities commonly cite "teamwork" as a graduate attribute and an integral part of their set of flexible and transferable skills suitable for different types of employment. This paper raises concerns as to whether teamwork as experienced in the university education system can claim to achieve the imparting of team skills. Pedagogically, learning through team work may be a useful educational tool however when the concept of 'teamwork' is explored a number of inconsistencies arise in the tertiary environment. The outcomes derived from team work do not generally satisfy the criteria for effective and efficient teamwork. However, it is suggested that to utilise teamwork as a learning tool for a graduate attribute the assessment criteria should take into consideration how the team worked together--the team dynamics.

Assessment in experiential learning : the case of a public policy internship

Assessment is a significant issue for learning in the workplace. In some professions there are key indicators of success shared by workplace and academic supervisors alike. Beyond specific professions, however, assessment becomes more diffuse in workplaces that do not have explicit criteria established to judge performance of students in experiential learning. Assessing learning in these workplaces may be associated with methods that rely more upon student self appraisal and workplace supervisor reports. This article reports on the approach used for assessment in a public policy internship program in one Australian university - Deakin University in Victoria. The article argues that assessment, rather than being an add-on or a test of pre-ordained information, is central to the process of learning itself. This means that before students embark upon a policy internship they need to build their critical thinking abilities; i.e. a process of purposeful, self- regulatory judgment. Secondly they need to discuss how to negotiate their tasks in different workplaces and how to produce the criteria to be used in their evaluation.

Delivery and assessment strategies to improve on- and off-campus student performance in structural mechanics

This paper considers the delivery and assessment strategies used in two structural mechanics units at Deakin University, a leader in distance education in Australia. The two units have had unacceptably high rates of student failure. Student perceptions of the delivery method were analysed and an investigation was carried out of the performance of 329 (173 on- and 156 off-campus) students enrolled in the two units. An analysis of the assignment, laboratory and examination marks is presented. Consideration is also given to the total marks. The results show that on-campus students performed better in structural mechanics than their off-campus counterparts. Plots of the distributions of student performance for the three assessment methods are provided (for each unit) and high failure rates are linked to low examination marks. Students tended to perform best in assignments and worst in examinations. Parametric statistical tests show a correlation between the marks obtained in continuous assessment and in examinations, and it is therefore proposed that, in order to improve performance, the students must be encouraged to participate fully in all aspects of the course. Many students were unenthusiastic about laboratory practical sessions and did not think they aided their understanding of the theoretical material. Motivation to participate is often dependent on the perceived relevance of a given task and its contribution to the total mark and, thus, to help motivate students to participate fully in the continuous assessment tasks, the authors propose several changes to the delivery methods, as well as to assessment criteria and marking schemes.

How architects incorporate ESD criteria into the design process

This paper will seek to answer; "How do architects in Victoria incorporate Ecologically Sustainable Development (ESD) criteria into the design process?" For the purpose of this paper, "Ecologically Sustainable Development" is defined in line with the judging criteria used by the Royal Australian Institute of Architects for the 'Sustainable Architecture Award'. The RAIA states that (Maddison, 2003 p.7), "the goal of sustainable architecture is to achieve development that improves the total quality of life, in a way that maintains the processes on which life depends. The project assessment covers ecologically sustainable development and energy efficient design:' By researching exemplary building projects that have been awarded a Victorian Sustainable Architecture Award, this paper will enlighten a design methodology for the pursuit of excellence in ecologically sustainable development. Key elements in the design process will be determined by comparing and analysing the processes of different architectural practices. This will be achieved through the study of published literature on the award winning designs, qualitative analysis of interviews with the architects who designed the selected projects and quantitative analysis of questionnaires completed by the architects.

System boundary selection in life-cycle inventories using hybrid approaches

Life-cycle assessment (LCA) is a method for evaluating the environmental impacts of products holistically, including direct and supply chain impacts. The current LCA methodologies and the standards by the International Organization for Standardization (ISO) impose practical difficulties for drawing system boundaries; decisions on inclusion or exclusion of processes in an analysis (the cutoff criteria) are typically not made on a scientific basis. In particular, the requirement of deciding which processes could be excluded from the inventory can be rather difficult to meet because many excluded processes have often never been assessed by the practitioner, and therefore, their negligibility cannot be guaranteed. LCA studies utilizing economic input−output analysis have shown that, in practice, excluded processes can contribute as much to the product system under study as included processes; thus, the subjective determination of the system boundary may lead to invalid results. System boundaries in LCA are discussed herein with particular attention to outlining hybrid approaches as methods for resolving the boundary selection problem in LCA. An input−output model can be used to describe at least a part of a product system, and an ISO-compatible system boundary selection procedure can be designed by applying hybrid input−output-assisted approaches. There are several hybrid input−output analysis-based LCA methods that can be implemented in practice for broadening system boundary and also for ISO compliance.

Teacher researchers - sustaining professional learning

In this paper we argue for an approach to professional development which supports teachers to engage in sustained intellectual inquiry and to investigate the conditions in their classrooms that might make a difference for students at risk of not succeeding at school. We focus on the work of one primary school teacher involved in the research project Teachers investigate unequal outcomes in literacy: Cross generational perspectives and explore the effects that redesigning her literacy curriculum had on her professional identity and the literacy outcomes for one of the children in her class. We suggest that the principles of building theory and practice, positioning teachers as agentive, and making a space for teachers to bring new – and renewed – professional knowledge to their work are principles of practice that energise and sustain teachers and their day-to-day classroom work. Such principles deserve attention, particularly at a time when teacher quality and professional standards are in the minds of policy makers.

Criteria for the systematic review of health promotion and public health interventions

Systematic reviews of public health interventions are fraught with challenges. Complexity is inherent; this may be due to multi-component interventions, diverse study populations, multiple outcomes measured, mixed study designs utilized and the effect of context on intervention design, implementation and effectiveness. For policy makers and practitioners to use systematic reviews to implement effective public health programmes, systematic reviews must include this information, which seeks to answer the questions posed by decision makers, including recipients of programmes. This necessitates expanding the traditional evaluation of evidence to incorporate the assessment of theory, integrity of interventions, context and sustainability of the interventions and outcomes. Unfortunately however, the critical information required for judging both the quality of a public health intervention and whether or not an intervention is worthwhile or replicable is missing from most public health intervention studies. When the raw material is not available in primary studies the systematic review process becomes even more challenging. Systematic reviews, which highlight these critical gaps, may act to encourage better reporting in primary studies. This paper provides recommendations to reviewers on the issues to address within a public health systematic review and, indirectly, provides advice to researchers on the reporting requirements of primary studies for the production of high quality systematic reviews.

Australian law students' perceptions of their values: interim results in the first year--2001--of a three--year empirical assessment

This study attempts to answer an essential social policy question: what values are characteristic of the mass of Australian lawyers' in their last year of law school and their early careers, and how do these values develop or degrade over time? This question is important because of the concern felt in the community as to the activities of lawyers. In recent years the Australian legal profession has sustained more scrutiny by governments, regulators and consumer movements than in any previous period of our history. The perception that practitioners' competencies and ethics are deficient and materially linked both to reduced standards of performance and to higher levels of public complaints, has received attention from academics, law societies, parliamentary committees and the Australian Competition and Consumer Commission.

Lymphedema after complete axillary node dissection for melanoma: assessment using a new, objective definition

Objectives: The objectives of this study were to define appropriate criteria for assessing the presence of lymphedema, and to report the prevalence and risk factors for development of upper limb lymphedema after level I-III axillary dissection for melanoma.
Summary Background Data: The lack of a consistent and reliable objective definition for lymphedema remains a significant barrier to appreciating its prevalence after axillary dissection for melanoma (or breast carcinoma).
Methods: Lymphedema was assessed in 107 patients (82 male, 25 female) who had previously undergone complete level I-III axillary dissection. Of the 107 patients, 17 had also received postoperative axillary radiotherapy. Arm volume was measured using a water displacement technique. Change in volume of the arm on the side of the dissection was referenced to the volume of the other (control) arm. Volume measurements were corrected for the effect of handedness using corrections derived from a control group. Classification and regression tree (CART) analysis was used to determine a threshold fractional arm volume increase above which volume changes were considered to indicate lymphedema.
Results: Based on the CART analysis results, lymphedema was defined as an increase in arm volume greater than 16% of the volume of the control arm. Using this definition, lymphedema prevalence for patients in the present study was 10% after complete level I-III axillary dissection for melanoma and 53% after additional axillary radiotherapy. Radiotherapy and wound complications were independent risk factors for the development of lymphedema.
Conclusions: A suggested objective definition for arm lymphedema after axillary dissection is an arm volume increase of greater than 16% of the volume of the control arm.

Assessment of wilderness quality using the analytic hierarchy process

Wilderness is a unique environmental resource that provides a multitude of use and non-use benefits. The use and management of wilderness depend on the assessment of wilderness quality. Current wilderness assessment in Australia is based on two broad criteria, the remoteness and naturalness of the wilderness, determined using geographic information systems. This paper discusses a complementary assessment method using the Analytic Hierarchy Process (AHP). The AHP can be used to incorporate additional criteria, such as social and cultural criteria, to improve the quality of wilderness assessment. It provides a flexible and compatible method for large-scale wilderness assessments with multiple criteria. The weighting factors for the different criteria can be obtained from expert panels and focus groups.

Changing places : testing the relevance of educational research and teacher education

Frequent reviews of teacher education in recent times seem to indicate that those charged with the responsibility for teacher education have little understanding of the contemporary needs of teachers. Just how does educational research inform teachers in their day-to-day practice and how is its relevance tested? As an educational researcher Professor Shirley Grundy challenges her own notions of 'relevance' by returning from academia to the school system in Western Australia. This experience expanded her understanding of how conceptual frameworks and the realities of schools complemented each other. She reflects on the agenda for change faced by education systems and the ensuing transformation of curriculum planning, pedagogy, assessment and reporting procedures in some schools while not in others.

Her reference to Habermas' work relating to 'system' and 'lifeworld' provided her with an explanation for the social conditions of schooling, while her exploration of discourse theory provides some understanding of the practices related to the exercise of power in school settings. Interchanges such as that experienced by Grundy are to the mutual benefit of both parties.

Supply chain security: the need for continuous assessment

Ease of Internet accessibility has offered business the opportunity to incorporate this electronic infrastructure technology into establishing electronic-based supply chains. With the improved efficiency that this brings to the management and functionality of the supply chain, there are also security considerations that should be taken into account for protecting the integrity of the electronic supply chain, not only within each business node, but also across the entire supply chain. Such security vulnerabilities can be negated with the implementation of security measures and policies, however these need to be consistent throughout the supply chain and regularly assessed against security benchmarks in order to ensure they meet dequate security standards.

Teacher or trainer? The shaping of teacher identity in adult education contexts

In response to changing government funding priorities there has been a shift away from the provision of needs based language and personal development courses for adults in community based contexts towards the delivery of vocational education. Much vocational education is characterized by competency-based curriculum and outcomes influenced by the needs of the current labour market as well as economic driven initiatives such as competitive tendering for short-term course funding. These trends have resulted in changes to the nature of curriculum, assessment, and the purpose and nature of the delivery of courses to adult learners. In turn, these changes affect the ways in which teachers see themselves and carry out their roles as professionals. This paper explores the ways in which the current discourses of vocational education shape teacher identities across a variety of vocational education contexts and the ways in which teacher identities are played out through training and teaching practices.

Trialing new assessment tools to identify women at risk of PND

Objectives: The objectives of this study were to trial the Postpartum Depression Predictors Inventory (PDPI) as a checklist to assist nurses in identifying women at risk of postnatal depression at 28 weeks of pregnancy, with repeated assessment at 6-8 weeks postpartum.

Methods: A prospective cohort design was used to include a population of women >20 years of age who were attending an antenatal clinic at a Victorian regional hospital. All women who attended the clinic for their 28 week visit were invited to participate over an 8-week period. Five data collection measures were included, two in the antenatal period and three at 6-8 weeks postpartum. Based on nurse consultation at both times, clinical judgement, and use of the PDPI, nurses recorded three outcomes: no identifiable risk, non-directive counselling or referral to a psychiatric nurse. The Postpartum Depression Screening Scale (PDSS), Edinburgh Postnatal Depression Scale (EPDS) and Kanzas Marital Satisfaction Scales were used at 6-8 weeks postpartum to assess depression and marital satisfaction.

Results: 107 women were recruited in the antenatal period with 84 being followed up 8 weeks postpartum. Information will be presented on the proportion of women who were found to be depressed at both data collection periods, the intervention outcomes as determined by nurses. The use of the PDPI and PDSS as tools to assist nurses in identifying women at risk of postnatal depression will be discussed.

Conclusion: The PDPI is a useful checklist to identify women at risk of postnatal depression. The PDSS and the EPDS identified a similar number of women, although the PDSS is a much longer and more intensive scale.