Nurses´ attitudes to single checking medications : before and after its use

We report nurses' attitudes towards the single checking of medications before and after the implementation of this procedure in an acute health-care setting. Data from a pre-implementation survey confirmed that some nurses held strong views against single checking. Following this survey, the hospital's medication administration policy was revised, a single checking resource manual was developed, 1–2 h nurse education sessions were held, the competencies of nurses to single check and to administer medications were assessed, and single checking was successfully piloted before hospital-wide implementation. Data from a survey conducted 18 months after the implementation indicated that nurses welcomed the single checking medication procedure, felt more confident using single checking and perceived that it made them more accountable for administering medications. The findings provide evidence that nurses' attitudes to single checking change remarkably in favour of its use with education and experience using this procedure.

Construct validity and reliability of the single checking administration of medications scale

Research indicates that single checking of medications is as safe as double checking; however, many nurses are averse to independently checking medications. To assist with the introduction and use of single checking, a measure of nurses' attitudes, the thirteen-item Single Checking Administration of Medications Scale (SCAMS) was developed. We examined the psychometric properties of the SCAMS. Secondary analyses were conducted on data collected from 503 nurses across a large Australian health-care service. Analyses using exploratory and confirmatory factor analyses supported by structural equation modelling resulted in a valid twelve-item SCAMS containing two reliable subscales, the nine-item Attitudes towards single checking and three-item Advantages of single checking subscales. The SCAMS is recommended as a valid and reliable measure for monitoring nurses' attitudes to single checking prior to introducing single checking medications and after its implementation.

The influence of confidence in memory on checking behaviours

Recent theories of Obsessive Compulsive Disorder have suggested that meta-cognitive beliefs, particular confidence in memory, may relate to the maintenance of symptoms. For example, individuals who worry that their memory is deficient may check in order to ensure that the doors are locked, regardless of their actual memory ability. While studies have related meta-memory beliefs to OCD symptoms, and have found that memory is affected by checking behaviours; to date, no experimental literature has attempted to ascertain whether lowered confidence in memory directly leads to greater checking behaviours. In the current study 46 non-clinical participants completed a battery of questionnaires measuring these constructs, before undertaking a “memory task” designed to manipulate their level of confidence in their memory. The effect of the manipulation on the level of checking on a visuomemory task was subsequently assessed. The questionnaires indicated that cognitive confidence predicted variation in obsessive-compulsive symptoms over-and-above the influence of depressive symptoms and other OCD-related beliefs. However, while confidence in memory was successfully manipulated, the group with increased memory confidence was not found to have lower checking behaviours. Limitations of the study are discussed and directions for further research are suggested.

Psychometric properties of a tool to measure nurses' attitudes to single checking medications: SCAMS-II

BACKGROUND AND AIMS: Single checking medications has been increasingly adopted over the past decade by nurses in Australian healthcare services. However, attitudes toward the practice of only one nurse checking medications remain unclear. The aim of this article is to report on the development, reliability, and validity of a tool to measure nurses' attitudes to single checking medications in a health service in which single checking has been in place for over a decade. METHODS: In a cross-sectional survey design, the Single Checking and Administration of Medications Scale (SCAMS-II) was used to measure the attitudes of 299 registered nurses (RNs) who were single checking medications in one metropolitan teaching hospital in Australia. Exploratory factor analysis was used to explore the dimensions that best represented the SCAMS-II. Cronbach's α was used to assess internal consistency of the identified subscales. To test the construct validity of the emergent questionnaire, Confirmatory Factor Analysis and Rasch analyses were performed. RESULTS: The psychometric properties of the SCAMS-II revealed 12 items with three reliable subscales: a five-item accountability model; a four-item efficiency model; and a three-item knowledge model. LINKING EVIDENCE TO ACTION: In settings where single checking is current practice, the SCAMS-II is recommended as a reliable tool to measure nurses' attitudes toward the single checking of medications. The findings from this study may assist healthcare organizations in the development of policy and procedure guidelines for the safe administration of medications.

Distributed data possession checking for securing multiple replicas in geographically-dispersed clouds

Distributing multiple replicas in geographically-dispersed clouds is a popular approach to reduce latency to users. It is important to ensure that each replica should have availability and data integrity features; that is, the same as the original data without any corruption and tampering. Remote data possession checking is a valid method to verify the replicass availability and integrity. Since remotely checking the entire data is time-consuming due to both the large data volume and the limited bandwidth, efficient data-possession- verifying methods generally sample and check a small hash (or random blocks) of the data to greatly reduce the I/O cost. Most recent research on data possession checking considers only single replica. However, multiple replicas data possession checking is much more challenging, since it is difficult to optimize the remote communication cost among multiple geographically-dispersed clouds. In this paper, we provide a novel efficient Distributed Multiple Replicas Data Possession Checking (DMRDPC) scheme to tackle new challenges. Our goal is to improve efficiency by finding an optimal spanning tree to define the partial order of scheduling multiple replicas data possession checking. But since the bandwidths have geographical diversity on the different replica links and the bandwidths between two replicas are asymmetric, we must resolve the problem of Finding an Optimal Spanning Tree in a Complete Bidirectional Directed Graph, which we call the FOSTCBDG problem. Particularly, we provide theories for resolving the FOSTCBDG problem through counting all the available paths that viruses attack in clouds network environment. Also, we help the cloud users to achieve efficient multiple replicas data possession checking by an approximate algorithm for tackling the FOSTCBDG problem, and the effectiveness is demonstrated by an experimental study. © 2011 Elsevier Inc.

Innovation theories in retrospect : the case of electronic commerce adoption in small business in New Zealand

A review of the technological innovation adoption literature on small to medium-sized enterprises (SMEs) provides useful insights into factors influencing innovation adoption but points to the need to introduce more determinants of innovation adoption to SMEs research. This research is interested in identifying these factors and hence, introducing more potential determinants to electronic commerce (EC) adoption research in SMEs. Therefore, this research attempts to extend the technological innovation theories to EC adoption research in SMEs by identifying potential constructs and factors from these theories and then checking their face validity using three case studies in New Zealand. This research endeavours to shortlist and discuss the most important determinants of EC adoption and to eliminate the least relevant ones.

Coronary angiography observations: evidence-based or ritualistic practice?

Objective: The purposes of this study were to describe the incidence and occurrence of femoral artery bleeding during the first 6 hours after coronary angiography and to determine whether there is a relationship between  current postangiogram observation protocols and the detection of  complications.

Design: This was a prospective descriptive study.

Setting: The study was conducted in 3 university hospitals in Melbourne, Australia.

Patients: Subjects included 55 patients representing the complication rate of 1075 patients, mean age 61 years (SD, 12), 69% male.

Results: About 5.1% of patients had 1 or more incidents of bleeding  requiring manual compression. In 4.2% of patients, bleeding occurred within 6 hours of angiography. Bleeding occurred a median of 2.02 hours (Q1 = 45 minutes, Q3 = 4.31 hours) after angiography. Patients without pressure bandaging bled a median of 1.32 hours (Q1 = 36.50 minutes, Q3 = 2.59 hours) after angiography. Patients with pressure bandaging bled a median of 4.75 hours (Q1 = 2.25 hours, Q3 = 7.28 hours) after angiography. In 40.6% of cases, bleeding was detected through the patient’s call for assistance, and in 59.4% of cases nurses noted bleeding while checking the puncture site. Postcatheter observations were recorded 23.70 (SD, 14.60) minutes before the bleeding incident. There were no significant changes in vital signs, systolic blood pressure (P > .05), diastolic blood pressure (P > .05), or pulse (P > .05) before or during a bleeding episode. All were within normal parameters. No neurovascular assessment anomalies were detected.

Conclusion: The use of pressure bandaging has a significant effect on the incidence and pattern of bleeding. Routine vital sign measurement has no relevance in detecting local complications after angiography. The most significant complication is bleeding that requires manual compression. Detection is through frequent puncture site observation and patient recognition and communication.

The role of the board in building strategic capability: towards an integrated model of sport governance research

Governance is a critical issue confronting sport organisations. Its importance in the management of sport organisations has been heightened due to the transition of many sports from predominantly volunteer administered organisations anchored in an amateur ethos, to professionally managed entities catering to a more sophisticated sport marketplace. This paper identifies four elements from the sport governance literature as the key research foci to date: shared leadership, board motivation, board roles, and board structure. Four generic themes (performance, conformance, policy and operations) are also examined and expressed as governance capabilities. The strategic role and performance of the board, while central to the practice of governance, is shown to be a weakness in many sport organisations. Further, the strategic role of the board is underdeveloped in the sport management and governance research literature. Finally, it is noted that the governance literature is shaped by a normative and prescriptive approach that may not fully encompass the diversity that exists within the sport setting. The paper concludes by identifying and affirming the critical gaps in our knowledge of sport governance. Future work should seek to understand sector-specific considerations, such as non-profit and commercial differences in sport; governance designs in response to changing environmental conditions; the impact of the CEO on the board's strategic contributions; and strategic activity by the board. More use of qualitative research methods to probe such issues is recommended

How well do ecosystem-based planning units represent different componenets of biodiversity?

There are many proposals for managing biodiversity by using surrogates, such as umbrella, indicator, focal, and flagship species. We use the term biodiversity management unit for any ecosystem-based classificatory scheme for managing biodiversity. The sufficiency of biodiversity management unit classification schemes depends upon (1) whether different biotic elements (e.g., trees, birds, reptiles) distinguish between biodiversity management units within a classification (i.e., coherence within classes}; and (2) whether different biotic elements agree upon similarities and dissimilarities among biodiversity management unit classes (i.e., conformance among classes). Recent evaluations suggest that biodiversity surrogates based on few or single taxa are not useful. Ecological vegetation classes are an ecosystem-based classification scheme used as one component for biodiversity management in Victoria, Australia. Here we evaluated the potential for ecological vegetation classes to be used as biodiversity management units in the box-ironbark ecosystem of central Victoria, Australia. Eighty sites distributed among 14 ecological vegetation classes were surveyed in the same ways for tree species, birds, mammals, reptiles, terrestrial invertebrates, and nocturnal flying insects. Habitat structure and geographic separations also were measured, which, with the biotic elements, are collectively referred to as variables. Less than half of the biotic element-ecological vegetation class pairings were coherent. Generalized Mantel tests were used to examine conformance among variables with respect to ecological vegetation classes. While most tests were not significant, birds, mammals, tree species, and habitat structure together showed significant agreement on the rating of similarities among ecological vegetation classes. In this system, use of ecological vegetation classes as biodiversity management units may account reasonably well for birds, mammals, and trees; but reptiles and invertebrates would not be accommodated. We conclude that surrogates will usually have to be augmented or developed as hierarchies to provide general representativeness.

Mining inconsistent secure messages toward analyzing security protocols

Traditional approaches such as theorem proving and model checking have been successfully used to analyze security protocols. Ideally, they assume the data communication is reliable and require the user to predetermine authentication goals. However, missing and inconsistent data have been greatly ignored, and the increasingly complicated security protocol makes it difficult to predefine such goals. This paper presents a novel approach to analyze security protocols using association rule mining. It is able to not only validate the reliability of transactions but also discover potential correlations between secure messages. The algorithm and experiment demonstrate that our approaches are useful and promising.

How graduate nurses use protocols to manage patients` medications

Aims and objectives. The aim of the study was to determine how graduate nurses use protocols in their medication management activities. The objectives were to: examine the extent of adherence to various protocols in relation to medication activities and determine how the ward environment impacts on graduate nurses' use of protocols to manage patients' medications.
Background. Protocols help newly qualified nurses integrate new knowledge into practice and promote effective decision-making
Design. A descriptive prospective qualitative design was used.
Methods. Twelve graduate nurses involved in direct patient care in medical, surgical and specialty wards of a metropolitan teaching hospital participated in the study. Participant observations were conducted with the graduate nurses during a two-hour period when medications were being administered to patients. In-depth interviews were conducted with each nurse immediately after observations and demographic data were collected on participating nurses and patients in their care, including all medications prescribed. Protocols associated with medication management activities for the clinical settings were also transcribed.
Results. Six themes were evident from the data: availability and use of protocols, scrutinizing patients' identity before medication administration, double-checking certain medications before administration, writing incident reports, following specific policies and timing the administration of medications.
Conclusion. Graduate nurses adhered to protocols if they were perceived not to impede with other nursing activities. Participants were also more likely to follow protocols if they felt encouraged to make their own decisions and if there was a decreased likelihood that disciplinary action would be involved.
Relevance to clinical practice. Experienced health professionals should encourage graduate nurses to comply with medication protocols and to make clinically reasoned decisions about medication activities. By providing peer support and acting as role models, experienced health professionals can also demonstrate to graduate nurses how effective protocol use is an important component of quality patient care.