An analysis of nursing students' decision-making in teams during simulations of acute patient deterioration

AIM: The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions.

BACKGROUND: Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted.

DESIGN: A descriptive exploratory design.

METHODS: Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed.

RESULTS: Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions.

CONCLUSIONS: Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students' decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication.

Single-room usage patterns and allocation decision-making in an Australian public hospital: a sequential exploratory study

AIMS AND OBJECTIVES: The aims are to (1) measure occupancy rates of single and shared rooms; (2) compare single room usage patterns and (3) explore the practice, rationale and decision-making processes associated with single rooms; across one Australian public health service.

BACKGROUND: There is a tendency in Australia and internationally to increase the proportion of single patient rooms in hospitals. To date there have been no Australian studies that investigate the use of single rooms in clinical practice.

DESIGN: This study used a sequential exploratory design with data collected in 2014.

METHODS: A descriptive survey was used to measure the use of single rooms across a two-week time frame. Semi-structured interviews were undertaken with occupancy decision-makers to explore the practices, rationale decision-making process associated with single-room allocation.

RESULTS: Total bed occupancy did not fall below 99·4% during the period of data collection. Infection control was the primary reason for patients to be allocated to a single room, however, the patterns varied according to ward type and single-room availability. For occupancy decision-makers, decisions about patient allocation was a complex and challenging process, influenced and complicated by numerous factors including occupancy rates, the infection status of the patient/s, funding and patient/family preference. Bed moves were common resulting from frequent re-evaluation of need.

CONCLUSION: Apart from infection control mandates, there was little tangible evidence to guide decision-making about single-room allocation. Further work is necessary to assist nurses in their decision-making.

RELEVANCE TO CLINICAL PRACTICE: There is a trend towards increasing the proportion of single rooms in new hospital builds. Coupled with the competing clinical demands for single room care, this study highlights the complexity of nursing decision-making about patient allocation to single rooms, an issue urgently requiring further attention.

Social inclusion and the fatosphere: the role of an online weblogging community in fostering social inclusion

Overweight and obesity are one of the most salient issues within society today, and the stigmatisation of overweight individuals is prevalent and widespread. Utilising interviews with 44 individuals who blog within an online fat acceptance community known as the Fatosphere, participants' perceptions of inclusion and exclusion were examined within their offline and online environments. Additionally, the effect this had on their offline lives was examined. Participants described a profound sense of exclusion within their offline lives through three agencies: the medicalisation of 'fatness', the weight loss industry and the media, which echoed descriptions of moral judgement. Furthermore, a sense of inclusion was described within the Fatosphere through the protection and support that they found within this 'safe space'. The effects of the Fatosphere influenced their lives in both negative and positive ways, allowing them to better deal with stigma and discrimination, but sometimes effecting their offline relationships in a negative manner. The Fatosphere provides a unique opportunity for corpulent individuals to engage in a community that is removed from the prominent weight-related discourse within modern society.

Transition: improved literacy outcomes research study

This paper reports on the Transition: Improved Literacy Outcomes Research Study established by the Department of Education and Training (DET). The purpose of the study was to identify the most useful and usable data for educators to access in order to ensure that student literacy learning is maximised during the transition from Primary to Secondary school.1. The research followed a mixed-methods approach, combining a statistically defensible sample of schools selected to represent school types (primary, secondary, combined), locations (rural, regional, urban) and all regions with a survey and follow- up interviews.2. The results are presented as a mixture of statistics, case studies and discussion. The case studies were developed from both survey data and interview data.3. Leaders and teachers overwhelmingly valued teacher judgement (through AusVELS) as the most useful data in understanding students’ strengths and weaknesses, followed by On-Demand testing.4. NAPLAN results were frequently transferred between schools, but were found to be less useful than other data by teachers.5. School leaders and teachers are currently using data for ability streaming, or for tailoring curriculum for individual student needs. A number of schools use the Literacy data for achieving a balance of student abilities within classes.6. Support for access to, and use of, data is mainly manual, with some use of spreadsheets.7. As the number of feeder Primary schools to a single Secondary school increases, data management becomes a much larger burden on the Secondary staff concerned.8. In Secondary schools, there was a clear demand for Literacy data, but these data were not always those that were being provided by their feeder Priamary schools. This mis-match appears to lead to some frustration among Literacy transition staff at both levels of schooling.9. A gap that needs filling is around the nature of the pedagogies at the two school levels. Not knowing, or misunderstanding, the approaches and needs of each level of schooling leads to the passing on of irrelevant Literacy data in some instances.10. The need for a common template for transition data was expressed by many Transition staff, both Primary and Secondary. In some instances the secondary school had set up a local template for this11. It would be advantageous for data to be directly up-loaded or transferred into a system via electronic tools already in use, such as an Excel spreadsheet.12. We would recommend that the capacity to provide some visualisation of data, and the compilation of internal Literacy data such as teacher judgements and AusVELS levels, or additional testing carried out by the school.13. Student background data was seen by many Secondary transition staff as being equally as valuable as more formal Literacy data for determining student needs.

Dont look back

The award-winning film Don't Look Back (1967) captures Bob Dylan on tour and on the cusp of change in 1965. Dylan was rapidly shedding his image as a folk musician and being reborn as a rock persona – and D. A. Pennebaker was there to record this fascinating transformation.This insightful book charts the ways in which Pennebaker revised aspects of observational 'direct cinema', a style of film-making that he helped to pioneer, in order to represent in innovative ways Dylan's onstage performances and backstage actions. Keith Beattie's perceptive and nuanced analysis explains the relationship between 'pose' and the performative presentation of 'persona', which forms the basis of the film's portrayal, and explores Pennebaker's relationship with Dylan in the film-making process. In doing so, the book highlights many remarkable moments fromDont Look Back and demonstrates how this landmark film eschewed the informationalism of the documentary form, revealing a captivating portrait of its beguiling subject.

Gilles Deleuze and early cinema: The modernity of the emancipated time

Although the transition from the movement-image to the time-image is among the most commented-upon Deleuzian problems, Gilles Deleuze neglected the previous transition from ‘images in movement’ to the first regime of the movement-images. As my approach will be transhistorical, focusing especially on early silent movies and recently expanded cinema through early moving images (Lumière Brothers) and 1970s structural films (Malcolm Le Grice), I will reflect on how we can think time and moving images outside of this closed Deleuzian movement-image/time-image conceptual framework. In other words, we can ask: how can we expand this conceptual framework? Drawing on David Martin-Jones’ ‘attraction-image’, my aim is to explore the role of early cinema and the reasons for Gilles Deleuze’s own historical and technical (mis)judgement of early silent cinema. In this sense, the emergent studies on the history of early silent movies, and the growing field of Deleuzian studies on film, together have an important role on the philosophical and historiographical analysis of film’s expression of time and modernity.

The long game: five years of simulating the Middle East

Scholarly literature attesting to the benefits of role play in teaching international relations or political science subjects is abundant and universally positive. However, despite many case studies presenting snapshots of single examples, long term data concerning a role play exercise is difficult to find. This study presents student feedback data gathered from 10 iterations of the Middle East politics simulation carried out over 5 years from 2011-15. The data obtained from over 600 respondents establishes very clear trends in terms of satisfaction, engagement, and workload. The findings demonstrate that students can be significantly engaged in the subject matter through role plays and that they value these opportunities and the learning that ensues, even though it may represent more work than they are used to allotting to traditional assignments. The results show that year after year, successive student cohorts have made a clear judgement that extra work is worthwhile when it pays off against their perceived learning. The inference can also be drawn that they do not see this same pay off when completing essay type assignments.

A study on truss bolt mechanism in controlling stability of underground excavation and cutter roof failure

The truss bolt reinforcement system has been used in controlling the stability of underground excavations in severe ground conditions and cutter roof failure in layered rocks especially in coal mines. In spite of good application reports, working mechanism of this system is largely unknown and truss bolts are predominantly designed based on past experience and engineering judgement. In this study, the reinforcing effect of the truss bolt system on an underground excavation in layered rock is studied using non-linear finite element analysis. Different indicators are defined to evaluate the reinforcing effects of the truss bolt system. Using these indicators one can evaluate the effects of a reinforcing system on the deformation, loosened area, failure prevention, horizontal movement of the immediate layer, shear crack propagation and cutter roof failure of underground excavations. Effects of truss bolt on these indicators reveal the working mechanism of the truss bolt system. To illustrate the application of these indicators, a comparative study is conducted between three different truss bolt designs. It is shown that the design parameters of truss bolt systems, including tie-rod span, length, and angle of the bolts can have significant effects on the reinforcing capability of the system.