Extended conversation pieces

Extended Conversation Pieces brings together conversations about art, and conversation as art. The exhibition features collaborative works by six Brisbane emerging artists, Catherine or Kate (Catherine Sagin and Kate Woodcroft), Scott Ferguson (Erika Scott and Brooke Ferguson) and Courtney Coombs and Caitlin Franzmann. These artists engage with ideas of contemporary feminism through processes of dialogue and exchange; exploring subjectivity, humour and intimacy in performance and installation works. Extended Conversation Pieces showcases the distinctive approach to contemporary practice at Boxcopy, an artist run initiative focused on supporting and commissioning new experimental works by Australian artists, and engaging with collaborative processes and practices.

Can music therapy in medical contexts ever be evidence-based?

This essay seeks to consider some of the issues around evidencethat provide an ongoing challenge to the profession of music therapyto be vigilant and critical with regards the undertaking, butalso the appropriation or application, of research in our alliedhealth discipline. It is written in response to the statement that“medical music therapists need to continue to discuss and debateour views as to what constitutes knowledge, expertise and ‘evidence’in our profession.” (Edwards, 2002, p. 33). A critical perspectiveto current demands for evidence is provided, and the useof quantitative method as the basis for trustworthy research inmusic therapy is discussed. The paediatric medical context is themain site of professional research of the author, however, some ofthe points made will have relevance for other fields of clinicalservice.

Exploring the myths of morphine in cancer: views of the general practice population

Abstract
Background: Morphine is widely used in cancer care, and understanding the concerns and perceptions of patients, family and friends is vital to managing pain and distress effectively. The ‘myths of morphine’ have frequently been discussed in medical literature, yet the extent to which such views are held is not clear. This qualitative project explores the perceptions and attitudes of the wider community towards morphine use in cancer care, to understand this ‘mythology’ according to those who in the future may themselves require its use.
Methods: Semi-structured interviews were held with patients presenting to a metropolitan general practice clinic in Melbourne, Australia. A grounded theory framework underpinned the data collection and thematic analysis undertaken.
Results: Interviewees (15) were aged 24 – 81, with a variety of experiences with cancer care and previous morphine use. Interviewees were highly supportive of morphine use in cancer care, with this attitude founded on the perceived severity of cancer pain and the powerful nature of morphine. They described a number of reasons morphine may be used in cancer care: to treat pain, to enable peace and also as a treatment for cancer.
Conclusion: The public view of morphine to emerge from this study is markedly different from that discussed in the myths of morphine. It is viewed as a medication that has the ability to provide peace and control both pain and the course of cancer. The participants in this study described a wish for greater involvement in pain control decisions, perceiving morphine as a facilitator rather than a barrier to good cancer care.

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.

Patient participation in nursing care on medical wards: An integrative review

BACKGROUND: Patient participation is a way for patients to engage in their nursing care. In view of the possible link between patient participation and safety, there is a need for an updated review to assess patient participation in nursing care. OBJECTIVES: To investigate patients' and nurses' perceptions of and behaviours towards patient participation in nursing care in the context of hospital medical wards. DESIGN: Integrative review. DATA SOURCES: Three search strategies were employed in August 2013; a computerised database search of Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Medline and PsychINFO; reference lists were hand-searched; and forward citation searching was executed. REVIEW METHODS: After reviewing the studies, extracting study data and completing summary tables the methodological quality was assessed using the Mixed-Methods Assessment Tool by two reviewers. Reviewers met then to discuss discrepancies as well as the overall strengths and limitations of the studies. Discrepancies were overcome through consensus or a third reviewer adjudicated the issue. Within and across study analysis and synthesis of the findings sections was undertaken using thematic synthesis. RESULTS: Eight studies met inclusion criteria. Four themes were identified - enacting participation, challenges to participation, promoting participation and types of participation. Most studies included were conducted in Europe. The majority of studies used qualitative methodologies, with all studies sampling patients; nurses were included in three studies. Data were largely collected using self-reported perceptions; two studies included observational data. Methodological issues included a lack of reflexivity, un-validated data collection tools, sampling issues and low response rates. CONCLUSIONS: On medical wards, patients and nurses desire, perceive or enact patient participation passively. Challenging factors for patient participation include patients' willingness, nurses' approach and confusion around expectations and roles. Information-sharing was identified as an activity that promotes patient participation, suggesting nurses encourage active communication with patients in practice. Involving patients in assessment and care planning may also enhance patient participation. For education, enhancing nurses' understanding of the attributes of patient participation, as well as patient-centred care approaches may be beneficial for medical ward nurses. From here, researchers need to examine ways to overcome the barriers to patient participation; further nurse participants and observational data is required on medical wards.

Patients' perceptions of participation in nursing care on medical wards

BACKGROUND: Patient participation benefits the patient and is a core concept of patient-centred care. Patients believe in their ability to prevent errors; thus, they may play a vital role in combating adverse event rates in hospitals. AIMS AND OBJECTIVES: To explore hospitalised medical patients' perceptions of participating in nursing care, including the barriers and facilitators for this activity. RESEARCH METHODS: This interpretive study was conducted on four medical wards, in two hospitals. Purposeful maximum variation sampling was operationalised to recruit patients that differed in areas such as age, gender and mobility status. In-depth semi-structured audiotaped interviews were undertaken and analysed using inductive content analysis. RESULTS: Twenty patients participated in the study. Four categories were uncovered in the data. First, valuing participation showed patients' willingness to participate, viewing it as a worthwhile task. Second, exchanging intelligence was a way of participating where patients' knowledge was built and shared with health professionals. Third, on the lookout was a type of participation where patients monitored their care, showing an attentive approach towards their own safety. Fourth, power imbalance was characterised by patients feeling their opportunities for participation were restricted. CONCLUSIONS: Patients were motivated to participate and valued participation. Cultivating this motivation may be crucial to patient empowerment and practices of safety monitoring, a fundamental strategy to addressing patient safety issues in hospitals. Engaging nurse-patient relationships, inclusive of knowledge sharing, is required in practice to empower patients to participate. Educating patients on the consequences of non-participation may motivate them, while nurses may benefit from training on patient-centred approaches. Future research should address ways to increase patient motivation and opportunities to participate.

Patient self-management in chronic heart failure – establishing concordance between guidelines and practice

 Chronic heart failure (CHF) is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. CHF patients are encouraged to self-manage their illness, such as adhering to medical regimens and monitoring symptoms, to optimise health outcomes and quality of life. In so doing, patients are asked to collaborate with their health service providers with regard to their care. However, patients generally do not self-manage well, even with specialist support. Moreover, self- management interventions are yet to demonstrate morbidity or mortality benefits. Social network approaches to self-management consider the availability and mobilisation of all resources, beyond those of only the patient and healthcare providers. Used in conjunction with e-health platforms, social network approaches may offer a means by which to optimise self-management programmes of the future.

Patterns of general practitioner usage among Pacific people: indicative results from the Waikato Medical Care Survey 1991-2

AIMS: To report patterns of medical contact in a representative sample of Pacific people attending the general practitioner. METHODS: The data were drawn from a survey of general practice in the Waikato region representing a one per cent sample of all weekday encounters. In total, 12,833 patient encounter forms were completed. Just over one per cent of all encounters were recorded for patients of Pacific Islands background. RESULTS: Rates of medical contact for Pacific patients were lower-3.4 visits per year versus 4.5 for the whole sample-fewer follow up visits were requested (71% versus 76.2%), presentation was delayed (4.9 days from onset versus 3.7 for the sample) and there was an apparently lower level of rapport achieved. CONCLUSION: Overall levels of medical contact and return visits among Pacific patients appear to be lower and presentation delayed in this Waikato sample.

Music therapy and medical ethnomusicology: distinctive and connected

A music therapist and an ethnomusicologist who is also qualified as a music therapist explore some of the ways in which music therapy and medical ethnomusicology might engage a dialogue that is helpful to expanding thinking and practice in both fields. We begin by describing music therapy and outlining some core concepts of therapeutic work. We then discuss ethnomusicology and reflect on the ways in which music therapy and ethnomusicology may complement one another in the field of medical ethnomusicology. We consider how an exploration of concepts informing cultural safety might be enacted in healthcare through the use of music and whether this might serve as a useful joint future enterprise between music therapists and medical ethnomusicologists. Finally we explain why we encourage medical ethnomusicologists to cease attempts to become applied therapeutic practitioners without further therapy skills training.

Learning clinical skills during bedside teaching encounters in general practice: a video-observational study with insights from activity theory

Purpose – This paper aims to explore how opportunities for learning clinical skills are negotiated within bedside teaching encounters (BTEs). Bedside teaching, within the medical workplace, is considered essential for helping students develop their clinical skills. Design/methodology/approach – An audio and/or video observational study examining seven general practice BTEs was undertaken. Additionally, audio-recorded, semi-structured interviews were conducted with participants. All data were transcribed. Data analysis comprised Framework Analysis informed by Engeström’s Cultural Historical Activity Theory. Findings – BTEs can be seen to offer many learning opportunities for clinical skills. Learning opportunities are negotiated by the participants in each BTE, with patients, doctors and students playing different roles within and across the BTEs. Tensions emerged within and between nodes and across two activity systems. Research limitations/implications – Negotiation of clinical skills learning opportunities involved shifts in the use of artefacts, roles and rules of participation, which were tacit, dynamic and changing. That learning is constituted in the activity implies that students and teachers cannot be fully prepared for BTEs due to their emergent properties. Engaging doctors, students and patients in refecting on tensions experienced and the factors that infuence judgements in BTEs may be a useful frst step in helping them better manage the roles and responsibilities therein. Originality/value – The paper makes an original contribution to the literature by highlighting the tensions inherent in BTEs and how the negotiation of roles and division of labour whilst juggling two interacting activity systems create or inhibit opportunities for clinical skills learning. This has signifcant implications for how BTEs are conceptualised.

The 'educational alliance' as a framework for reconceptualizing feedback in medical education

Feedback has long been considered a vital component of training in the health professions. Nonetheless, it remains difficult to enact the feedback process effectively. In part, this may be because, historically, feedback has been framed in the medical education literature as a unidirectional content-delivery process with a focus on ensuring the learner's acceptance of the content. Thus, proposed solutions have been organized around mechanistic, educator-driven, and behavior-based best practices. Recently, some authors have begun to highlight the role of context and relationship in the feedback process, but no theoretical frameworks have yet been suggested for understanding or exploring this relational construction of feedback in medical education. The psychotherapeutic concept of the "therapeutic alliance" may be valuable in this regard.In this article, the authors propose that by reorganizing constructions of feedback around an "educational alliance" framework, medical educators may be able to develop a more meaningful understanding of the context-and, in particular, the relationship-in which feedback functions. Use of this framework may also help to reorient discussions of the feedback process from effective delivery and acceptance to negotiation in the environment of a supportive educational relationship.To explore and elaborate these issues and ideas, the authors review the medical education literature to excavate historical and evolving constructions of feedback in the field, review the origins of the therapeutic alliance and its demonstrated utility for psychotherapy practice, and consider implications regarding learners' perceptions of the supervisory relationship as a significant influence on feedback acceptance in medical education settings.

Family physician preceptors' conceptualizations of health advocacy: implications for medical education

PURPOSE: Despite its official acceptance as an important physician responsibility, health advocacy remains difficult to define, teach, role model, and assess. The aim of the current study was to explore physicians' conceptions of health advocacy based on their experience with health-advocacy-related activities. METHOD: In 2012, the authors conducted 11 semistructured interviews with family physician clinical preceptors and analyzed the interviews in the tradition of phenomenography. RESULTS: The authors identified three distinct but related ways of understanding health advocacy: (1) Clinical: Health advocacy as support of individual patients in addressing health care needs related to the immediate clinical problem within the health care system, (2) Paraclinical: Health advocacy as support of individual patients in addressing needs that the physician preceptors viewed as peripheral yet parallel to both the health care system and the immediate clinical problem, and (3) Supraclinical: Health advocacy as population-based activities aimed at practice- and system-level changes that address the social determinants of health. CONCLUSIONS: The qualitatively different understandings of health advocacy shed light on why current approaches to defining, teaching, role modeling, and assessing health advocacy competencies in medical education appear idiosyncratic. The authors suggest the development of an inclusive and extensive conceptual framework that may allow the medical education community to imagine novel ways of understanding and engaging in health advocacy.

How do homeopaths reason and make decisions? Integrating theory, practice, and education

BACKGROUND: Homeopathy is a major modality in complementary and alternative medicine. Significant tensions exist between homeopathic practice and education, evident in the diversity of practice styles and pedagogic models. Utilizing clinical reasoning knowledge in conventional medicine and allied health sciences, this article seeks to identify and critique existing research in this important area. MATERIALS AND METHODS: A literature search utilizing MEDLINE,(®) Allied and Complementary Medicine (AMED), and CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature) was conducted. Key terms including clinical thinking, clinical reasoning, decision-making, homeopathy, and complementary medicine were utilized. A critical appraisal of the evidence was undertaken. RESULTS: Four (4) studies have examined homeopathic clinical reasoning. Two (2) studies sought to measure and quantify homeopathic reasoning. One (1) study proposed a reasoning model, based on pattern recognition, hypothetico-deductive reasoning, intuition, and remedy-matching (PHIR-M), resembling much that has been previously mapped in conventional medical reasoning research. The fourth closely investigated the meaning and use of intuition in homeopathic decision-making. CONCLUSIONS: Taken together, these four studies provide valuable insight into what is currently known about homeopathic clinical reasoning. However, despite the history and breadth of practice, little is known about homeopathic clinical reasoning and decision-making. Building on the research would require viewing clinical reasoning not only as a cognitive phenomenon but also as a situated and interactive one. Further research into homeopathic clinical reasoning is indicated.

Discharge communication from inpatient care: an audit of written medical discharge summary procedure against the new National Health Service Standard for clinical handover

OBJECTIVE: To audit written medical discharge summary procedure and practice against Standard Six (clinical handover) of the Australian National Safety and Quality Health Service Standards at a major regional Victorian health service. METHODS: Department heads were invited to complete a questionnaire about departmental discharge summary practices. RESULTS: Twenty-seven (82%) department heads completed the questionnaire. Seven (26%) departments had a documented discharge summary procedure. Fourteen (52%) departments monitored discharge summary completion and 13 (48%) departments monitored the timeliness of completion. Seven (26%) departments informed the patient of the content of the discharge summary and six (22%) departments provided the patient with a copy. Seven (26%) departments provided training for staff members on how to complete discharge summaries. Completing discharge summaries was usually delegated to the medical intern. CONCLUSIONS: The introduction of the National Service Standards prompted an organisation-wide audit of discharge summary practices against the external criterion. There was substantial variation in the organisation's practices. The Standards and the current audit results highlight an opportunity for the organisation to enhance and standardise discharge summary practices and improve communication with general practice.

Building the computational virtual reality environment for anaesthetists' training and practice

Understanding the real world based on visualisation and prediction is essential for the decision-maker. We build a computational virtual reality environment to improve visualisation, understanding and prediction of the physical world and to guide action. It develops a five-dimensional, computer-generated, computational Virtual Reality Environment for Anaesthesia (VREA). Our online prediction will be calculated based on the correlation and composition computing with respect to the three dimensions: horizontal, vertical and individual. The novel musical notes based anesthetic simulator is proposed to identify the abnormality and visualize the online medical time series. The experiments with the online ECG data will present a real-time case to show the effectiveness and efficiency of our proposed system and algorithms.