Putting woman-centered care into practice : a new (ANEW) approach to psychosocial risk assessment during pregnancy

Background: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy.

Methods: ANEW used a before‐and‐after survey design to evaluate the effects of a 6‐month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self‐rated communication skills, and open‐ended questions about participants' experience of the educational program.

Results: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program.

Conclusions:The program increased the self‐reported comfort and competency of health professionals to identify and care for women with psychosocial issues.

Addressing the contradiction between discourse and practice in health promotion

The main theme of this thesis is the contradiction between discourse and practice in health promotion. Many health promoters continue to exert power-over the community through top-down programming whilst at the same time using an emancipatory discourse. The thesis has addressed this contradiction in three parts. The first part determines how the emancipatroty discourse has evolved and eplores the role of social movements in the development of contemporary health discourses and their influence on the legitimisation of empowerment. Central to this discourse is the empowerment of communities. To understand the role of this concept the thesis provides an interpretation of the different meanings of power and community, and the different levels of analysis of empowerment in the context of health promotion programming. The second part identifies the nature of health programming and the dominance of top-down, and to a much lesser extent, bottom-up approaches. The thesis argues that these two approaches are not, and do not have to be, mutually exclusive. To address this issue the thesis presents a new methodology is situated within a framework developed for the accomodation of empowerment goals within health promotion programmes. The study also identifies the organisational areas of influence on the processs of community empowerment and it is these which are used for the assessment of this concept. Both the framework and the methodology address the contradiction in health promotion by making community empowerment operational within a programme context. The third part of the thesis supports the rationale for the design of the methodology with field work in rural Fijian communities. The findings are presented as a composite case study to highlight the experiences of implementing the methodolgy and the main themes that emerged during the field work. the final chapter of the thesis brings together the central themes of the study and draws from these and 'emergent agenda' as a way forward for health promotion research and practice.

Incorporating design explanation within formal object-oriented method (FOOM)

Requirements engineering is a commencing phase in the development of either software applications or information systems. It is concerned with understanding and specifying the customer's requirements of the system to be delivered. Throughout the literature, this is agreed to be one of the most crucial and, unfortunately, problematic phases in development. Despite the diversity of research directions, approaches and methods, the question of process understanding and management is still limited. Among contemporary approaches to the improvement of the current practice of Requirements Engineering, Formal Object-Oriented Method (FOOM) has been introduced as a new promising solution. The FOOM approach to requirements engineering is based on a synthesis of socio-organisational theory, the object-oriented approach, and mathematical formal specification. The entire FOOM specification process is evolutionary and involves a large volume of changes in requirements. During this process, requirements evolve through various forms of informal, semi-formal, and formal while maintaining a semantic link between these forms and, most importantly, conforming to the customer's requirements. A deep understanding of the complexity of the requirements model and its dynamics is critical in improving requirements engineering process management. This thesis investigates the benefits of documenting both the evolution of the requirements model and the rationale for that evolution. Design explanation explains and justifies the deliberations of, and decisions made during, the design activity. In this thesis, design explanation is used to describe the requirements engineering process in order to improve understandability of, and traceability within, the evolving requirements specification. The design explanation recorded during this research project is also useful in assisting the researcher in gaining insights into the creativity and opportunistic characteristics of the requirements engineering process. This thesis offers an interpretive investigation into incorporating design explanation within FOOM in order to extend and advantage the method. The researcher's interpretation and analysis of collected data highlight an insight-driven and opportunistic process rather than a strictly and systematically predefined one. In fact, the process was not smoothly evolutionary, but involved occasional 'crisis' points at which the model was reconceptualised, simplified and restructured. Therefore, contributions of the thesis lie not only in an effective incorporation of design explanation within FOOM, but also a deep understanding of the dynamic process of requirements engineering. The new understanding of the complexity of the requirements model and its dynamics suggests new directions for future research and forms a basis for a new approach to process management.

Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting

Background. Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization. However, the research–practice gap remains a persistent issue for the nursing profession.

Aims and objectives. The aim of this study was to gain an understanding of perceived influences on nurses' utilization of research, and explore what differences or commonalities exist between the findings of this research and those of studies that have been conducted in various countries during the past 10 years.

Design. Nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. The instrument comprised a 29-item validated questionnaire, titled Barriers to Research Utilisation Scale (BARRIERS Scale), an eight-item scale of facilitators, provision for respondents to record additional barriers and/or facilitators and a series of demographic questions.

Method. The questionnaire was administered in 2001 to all nurses (n = 761) working at a major teaching hospital in Melbourne, Australia. A 45% response rate was achieved.

Results. Greatest barriers to research utilization reported included time constraints, lack of awareness of available research literature, insufficient authority to change practice, inadequate skills in critical appraisal and lack of support for implementation of research findings. Greatest facilitators to research utilization reported included availability of more time to review and implement research findings, availability of more relevant research and colleague support.

Conclusion. One of the most striking features of the findings of the present study is that perceptions of Australian nurses are remarkably consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade.

Relevance to clinical practice. If the use of research evidence in practice results in better outcomes for our patients, this behoves us, as a profession, to address issues surrounding support for implementation of research findings, authority to change practice, time constraints and ability to critically appraise research with conviction and a sense of urgency.

A review of cashmere nutrition experiments with suggestions for improving their design and conduct

The scientific literature contains divergent views about the effects of nutrition on cashmere. The consequences of ignoring nutrition will be an increase in the number of goats suffering lower production, increased welfare risks and premature mortality. This review evaluated published reports to identify current knowledge and best practice in regard to the design and management of cashmere nutrition experiments. The ability of experiments to distinguish between treatments was evaluated based on their statistical evidence. Many experiments had serious deficiencies in their design, conduct and reporting. Six of 16 papers did not provide statistical information that would enable a reader to verify differences between treatments. For most experiments to detect nutrition affects at P < 0.05, they required a difference between treatments of 0.2–0.8 μm in cashmere mean fibre diameter and 15–42 g in clean cashmere production. Government Research Institutes research was characterised by more experienced authors conducting longer (P < 0.05) and larger (P < 0.05) experiments than those conducted by Universities. Much of the “debate” regarding the affects of nutrition on cashmere production arises from the misinterpretation of both experiments that did not detect statistically significant effects and of experiments that did detect statistically significant effects. Based on a comparison between experiments reporting responses to nutrition with those reporting no response, 13 design and management features were identified that are related to the ability of experiments to detect significant treatment affects. Methods must be adopted to reduce the variance in cashmere production within treatments, by using sufficient animals per treatment, and having replication to provide sufficient degrees of freedom to reduce error terms in analysis. The power of experimental designs should be evaluated before experiments commence. Cashmere production records from a previous full production year could be used as co-variants during statistical analyses but this requires that potential experimental goats are managed in one flock, without variations resulting from different grazing, reproduction or other management for a year prior to an experiment. It is preferable to use more productive and older goats, and goats that are used to handling, and to the conditions and feed to be used. Allocation of animals to treatments must take into account live weight. Nutrition treatments need to be sufficiently different to produce different growth curves. An appropriate control is needed such as live weight maintenance. Evidence of both nutrition intake and growth curves must be published with cashmere production data so the claims made can be verified by the actual responses. As cashmere production is an order of magnitude less than fibre production of Merino sheep or Angora goats and is more difficult to measure, the requirements for measurement, sampling and testing cashmere fleeces are summarised. The use of mid side cashmere patches to determine cashmere growth and quality is seriously biased and must be avoided, preferably by shearing goats prior to and at the end of experiments. In order to obtain higher fleece growth responses and improve the ability of experiments to detect treatment effects it is preferable to start cashmere growth experiments by midsummer and conduct experiments for at least 4 months. These requirements make it difficult for many university students to plan, undertake and complete long-term cashmere nutrition experiments without considerable management support. It is not possible for experiments to disprove the Null hypothesis regarding the effects of nutrition on cashmere production as they can only report a failure to detect treatment effects. Researchers and journals need to be more rigorous in providing statistical information including: degrees of freedom for error terms, treatment variances, standard error of differences or similar to enable readers to compare treatment effects. Publications that do not provide sufficient statistical information should be disregarded from future discussions. Claims that an experiment shows no responses to nutrition should be subject to rigorous examination using the issues identified in this review.

Maintaining change programmes for offenders : some suggestions for practice

Despite the widespread acceptance that follow-up or maintenance sessions are an important part of the change process for those who have completed offender rehabilitation programmes, there have been few attempts to articulate the basis upon which such sessions might be developed. This paper reviews the current theoretical and empirical literature relating to maintenance programmes, concluding that whilst there are a number of theories which might be relevant to the design of effective maintenance programmes, there is almost no empirical basis from which to make any assessment of their likely value or effectiveness.

Scaling up community-based obesity prevention in Australia : background and evaluation design of the health promoting communities : being active eating well initiative

Background : There is only limited evidence available on how best to prevent childhood obesity and community-based interventions hold promise, as several successful interventions have now been published. The Victorian Government has recently funded six disadvantaged communities across Victoria, Australia for three years to promote healthy eating and physical activity for children, families, and adults in a community-based participatory manner. Five of these intervention communities are situated in Primary Care Partnerships and are the subject of this paper. The interventions will comprise a mixture of capacity-building, environmental, and whole-of-community approaches with targeted and population-level interventions. The specific intervention activities will be determined locally within each community through stakeholder and community consultation. Implementation of the interventions will occur through funded positions in primary care and local government. This paper describes the design of the evaluation of the five primary care partnership-based initiatives in the 'Go for your life' Health Promoting Communities: Being Active Eating Well (HPC:BAEW) initiative.

Methods/Design : A mixed method and multi-level evaluation of the HPC:BAEW initiative will capture process, impact and outcome data and involve both local and state-wide evaluators. There will be a combined analysis across the five community intervention projects with outcomes compared to a comparison group using a cross-sectional, quasi-experimental design. The evaluation will capture process, weight status, socio-demographic, obesity-related behavioral and environmental data in intervention and comparison areas. This will be achieved using document analysis, paper-based questionnaires, interviews and direct measures of weight, height and waist circumference from participants (children, adolescents and adults).

Discussion : This study will add significant evidence on how to prevent obesity at a population level in disadvantaged and ethnically diverse communities. The outcomes will have direct influence on policy and practice and guide the development and implementation of future obesity prevention efforts in Australia and internationally.

Improving the quality of diabetes care in general practice

Objective: The evidence treatment gap for patients with type 2 diabetes.
Design: A summary of convenience sample of seven general practices.
Setting: Metropolitan and rural Victoria, Australia.
Participants: 561 patients of general practices (75% from rural general practices).
Main outcome measures: Demographic data, duration of diabetes, diabetes complications, HbA1c and lipid levels, blood pressure and score on PHQ-9.
Results: Patients with depression show more severe, progressive and intensively treated diabetes. The prevalence of depression in diabetes is about twice that of the general population.
Conclusion: Australian guidelines for diabetes should recommend screening for depression.

Scope of practice of occupational therapists working in Victorian community health settings

Background/aim: Current health policy places emphasis on community-based health care and it is expected that there will be an increase in the number of people receiving care in community settings. This study aimed to examine the profile and scope of practice of occupational therapists working in Victorian community health settings and the amount and type of health promotion activity incorporated into their role.
Method:  An anonymous postal questionnaire was sent to 205 community-based Victorian occupational therapists. One hundred and one (49.3% response rate) questionnaires were returned, with 72 respondents (35.1%) meeting study inclusion criteria. A descriptive research design was used to address study aims.
Results:  Results indicate that the majority of community health occupational therapists are experienced practitioners, have a varied scope of practice and report a high level of job satisfaction. Compared with previous studies, there is an increase in new graduate occupational therapists starting their career in community health settings, a greater number of part-time workers and a diversification of clinical and non-clinical roles. Barriers to practice that exist include high demand for service, limited funding and time spent on administrative tasks. Although health promotion was regarded as an important role of community health workers, a large number of therapists were not involved in this activity because of limited knowledge and clinical work taking priority.
Conclusion: Study findings have implications for occupational therapy training, and there is a clear need for input at policy level to address the significant resource allocation issues raised.

On representation and construction in a tectonic design studio

This study investigates the roles of representationand construction in enhancing students' learning in a tectonic design studio.  Students of architecture use 3D CAD, physical models and drawings, either alone or in hybrid combinations in the the design, development and communication of their design process.  Each of these media has intrinsic attributes that limit or enhance students' ability to engage in issues of architecture.  This can have a significant influence on students' learning of conceptual and tectonic design, in particularly in their early years of study.  Tectonic design, as an element of the architectural design process that involves the designerly consideration of issues of construction, is an important skill that is integral to architectural practice.  The unique problem based learning environment of the design studio offers opportunities for the development of deep learning approaches to tectonic design, however these are limited by the way students engage in representational media.  This research is based on an ethnographis case study of a cohort of second year architecture students at Deakin University, Geelong, in 2002.

Design management methodology to strengthen firm and industry competitiveness in the construction design services export sector

The aim of this research was to investigate strategies deployed by successful construction design-related firms towards achieving high levels of firm competitiveness in international markets. A reflexive capability model, developed through a critical analysis of related internationalisation literature, is composed of three key areas; internationalisation process, market knowledge and design management. Firm reflexive capability is explored through the management of social, cultural and intellectual capital. The concept of reflexivity is borrowed from sociology. Reflexivity is reinterpreted as the ‘firm’s’ ability to be aware, responsive and adaptable to self, market and project needs assessment. A cross case analysis explored the barriers and success factors through three constructs; internationalisation process, design management and market knowledge of three firms. This paper demonstrates that international firm competitiveness is dependent upon the strategic inter-relational management of social, cultural and intellectual capital for maximum advantage of the utilisation and leverage of one form of capital to gain another. This leads to the development of increasing reflexive capability to support internationalisation. An outcome of this research is the identification of the central relation between a level of reflexive capability within the firm and the firm’s level of success in international markets. This research is part of an ongoing program of research on international collaborative practice. A Reflexive Capability Matrix was developed from the findings of one research project and then validated through a second research project (only the capability matrix is presented in this paper though). The reflexive capability approach is appropriate to all firms but what is speculated upon is that the reflexive capability is particularly intrinsic to small to medium sized construction design firms who work globally. A reflexive capability is a characteristic of successful and innovative firms internationalising and working within global models of practice.

The development of a theoretical model for firm design management to support internationalisation processes

The aim of this research was to investigate strategies deployed by successful construction design related firms towards achieving high levels of firm competitiveness in international markets. A reflexive capability model, developed through a critical analysis of related internationalisation literature, is composed of three key areas; internationalisation process, market knowledge and design management. Firm reflexive capability is explored through the management of social, cultural and intellectual capital. The concept of reflexivity is borrowed from sociology the philosophers, Bourdieu and Giddens. Reflexivity is reinterpreted as the ‘firm’s’ ability to be aware, responsive and adaptable to self, market and project needs assessment. This research is part of an ongoing program of research on international collaborative practice. A Reflexive Capability Matrix is proposed. The reflexive capability approach is appropriate to all firms but what is speculated upon is that the reflexive capability is particularly applicable to small to medium sized construction design firms who work globally. A reflexive capability is a characteristic of successful and innovative firms internationalising and working within global models of practice. This paper is the theoretical development to support the paper in this congress “Design Management Methodology to Strengthen Firm and Industry Competitiveness in the Construction Design Services Export sector” where the methodology and results of a cross case analysis of three construction design firms are presented.

Vignette 6 Pluridisciplinary learning and assessment : reflections on practice

While designing group assessment for student learning outcomes is always difficult, the task is made more challenging in an interdisciplinary context. How much focus should be placed on assessment of discipline-specific knowledge, how much on the interdisciplinary knowledge that emerges as students work together in a non-linear, co-rational design and how much on the group dynamic (generic capabilities) being developed? While additional learning outcomes can be expected from the activities in which students engage in an interdisciplinary context, there is also an expectation, particularly for disciplines such as accounting, engineering and architecture where courses are professionally accredited, that discipline-specific learning outcomes are not compromised. This vignette presents some of the complexities that surfaced during the implementation of a pilot course designed as an experiential real world of work challenge for student.

Interconnecting networks of practice for professional learning

The article explores the complementary connections between communities of practice and the ways in which individuals orchestrate their engagement with others to further their professional learning. It does so by reporting on part of a research project conducted in New Zealand on teachers’ online professional learning in a university graduate diploma program on ICT education. Evolving from social constructivist pedagogy for online professional development, the research describes how teachers create their own networks of practice as they blend online and offline interactions with fellow learners and workplace colleagues. Teachers’ perspectives of their professional learning activities challenge the way universities design formal online learning communities and highlight the potential for networked learning in the zones and intersections between professional practice and study.
The article extends the concepts of Lave and Wenger’s (1991) communities of practice social theory of learning by considering the role participants play in determining their engagement and connections in and across boundaries between online learning communities and professional practice. It provides insights into the applicability of connectivist concepts for developing online pedagogies to promote socially networked

A partnership in induction and mentoring : noticing how we improve our practice

This article focuses on the induction and mentoring of early career teachers. The context is a suburban primary school in Victoria, Australia, as the school develops mentoring networks for graduate and beginning teachers. Instigated from a school–university partnership, the research draws from the traditions of practitioner research. In the research design and likewise in successful mentoring the importance of a genuine commitment to the discipline of reflective practice or what we have come to describe as “ noticing ” (Mason, 2002; Moss et al., 2004) is illustrated. The approach offers a new method for small scale–close up research in teacher education.