Developing a process model for deployment of radion frequency identification technology (RFID) in hospitals : an action research framework

Radio Frequency Identification (RFlD) technology is increasingly being explored for deployment in hospitals to improve their existing processes. In recent years, RPID pilots has lead to full scale implementation in hospitals, especially for tracking of expensive equipment as well as movable assets that are critical in surgeries. However, academic research is yet to emerge with a generic process model that can be adapted contextually for deployment of RPID in particular hospital settings. In this paper, we propose an action research framework for a pilot implementation of RPID in a large Indian hospital, the experiences of which will contribute to and result, in the development of such a process model.

Does an evidence-based sedation protocol improve practice and patient outcomes in critical care?

Learning Objective 1: compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care.

Learning Objective 2: explain the contrasting international research findings on sedation protocol implementation.
Minimization of sedation in critical care patients has recently received widespread support. Professional organizations internationally have published sedation management guidelines for critically ill patients to improve the use of research in practice, decrease practice variability and shorten mechanical ventilation duration. Innovations in practice have included the introduction of decision making protocols, daily sedation interruptions and new drugs and monitoring technologies. The aim of this study was to compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care setting.

A randomized, controlled trial design was used to study 312 mechanically ventilated adult patients in a general critical care unit at an Australian metropolitan teaching hospital. Patients were randomly assigned to receive protocol directed sedation management developed from evidence based guidelines (n=153) or usual clinical practice (n=159).

The median (95% CI) duration of ventilation was 58 hrs (44–78 hrs) for patients in the non-protocol group and 79 hrs (56–93) for those patients in the protocol group (p=0.20). Results were not significant for length of stay in critical care or hospital, the frequency of tracheostomies, and unplanned extubations. A Cox proportional hazards model estimated that protocol directed sedation management was associated with a 22% decrease (95% CI: 40% decrease to 2% increase, p=0.07) in the occurrence of successful weaning from mechanical ventilation.

Few randomized controlled trials have evaluated the effectiveness of protocol-directed sedation outside of North America. This study highlights the lack of transferability between different settings and different models of care. Qualified, high intensity nursing in the Australian critical care setting facilitates rapid, responsive decisions for sedation management and an increased success rate for weaning from mechanical ventilation.

The application of the transtheoretical model to offender populations : some critical issues

Purpose : Over the past two decades, the transtheoretical model (TTM) of change has become perhaps the most widely used model of behaviour change in the treatment of addictive and/or problem behaviours. More recently, the stages of change component of the TTM has been adopted for use in forensic settings. This paper aims to review the application of the TTM model to offender populations.

Arguments : The application of the TTM to offenders raises a number of issues regarding the process of behaviour change for offenders attending treatment programmes. It is argued that while the TTM has been designed to account for high frequency behaviour (e.g. smoking, alcohol misuse), offending behaviour may be less frequent and the process of change less cyclical. Moreover, it is suggested that the most important issue in a treatment context is the proper integration of the TTM constructs. There have been few empirical tests of this aspect of the model.

Conclusion : While the TTM may have some value in explaining how rehabilitation programmes help offenders to change their behaviour, the stages of change construct is, by itself, unlikely to adequately explain the process by which offenders desist from offending.

Maximising the benefits of radio frequency identification technology (RFID) integration in clinical contexts : a linear conduit

Radio Frequency Identification Technology (RFIO) has been explored for various process enhancements in clinical contexts, particularly hospitals, for asset tracking. The technology has been accepted in such environments, as it is inexpensive and, in principle, uncomplicated to integrate with other clinical support systems. It is perceived to offer many benefits to currently resource critical/strained clinical environments. This research investigation focuses on the exploitation of the potential of the technology, to enhance processes in clinical environments. In this paper, the researchers aimed to uncover if the technology, as presently deployed, has been able to achieve its potential and, in particular, if it has been fully integrated into processes in a way that maximises the benefits that were perceived. This research is part of a larger investigation that aims to develop a meta-model for integration of RFIO into processes in a form that will maximise benefits that may be achievable in clinical environments. As the first phase of the investigation, the key learning from a clinical context (hospital), which has deployed RFIO and attempted to integrate it into the processes, to enable better efficiencies, is presented in this paper. The case method has been used as a methodological framework. Two clinical contexts (hospitals) are involved in the larger project, which constitutes two phases. In Phase 1, semi structured interviews were conducted with a selected number of participants involved with the RFIO deployment project, before and after, in clinical context 1 (hereinafter named as CCl). The results were then synthesised drawing a set of key learning, from different viewpoints (implementers and users), as reported in this paper. These results outline a linear conduit for a new proposed implementation (CC2). On completion of the phase II, the researchers aim to construct a meta-model for maximising the potential of RFIO in clinical contexts. This paper is limited to the first phase that aims to draw key learning to inform the linear conduit.

Critical analysis and comparative study of security for networked RFID systems

The Radio frequency identification (RFID) system is a new technology which uses the open air to transmit information. RFID technology is one of the most promising technologies in the field of ubiquitous computing which is revolutionizing the supply chain. It has already been applied by many major retail chains such as Target, Wal-Mart, etc. The networked RFID system such as supply chain has very unique and special business needs which lead to special sets of RFID security requirements and security models. However, very little work has been done to analyze RFID security parameters in relation to networked RFID systems business needs. This paper presents a critical analysis of the networked application's security requirements in relation to their business needs. It then presents a comparative study of existing literature and the ability of various models to protect the security of the supply chain in a RFID deployment.

The functional significance of ventilation frequency, and its relationship to oxygen demand in the resting brown long-eared bat, Plecotus auritus

Mean oxygen consumption and simultaneous ventilation frequency of nine non-reproductive brown long-eared bats (body mass 8.53–13.33 g) were measured on 159 occasions. Ambient (chamber) temperature at which the measurements were made ranged from 10.8 to 41.1°C. Apneic ventilation occurred in 22 of the 59 measurements made when mean oxygen consumption was less than 0.5 ml·min-1. No records of apneic ventilation were obtained when it was over 0.5 ml·min-1. The relationship between ventilation frequency and mean oxygen consumption depended on whether ventilation was apneic or non-apneic. When ventilation was non-apneic the relationship was positive and log-linear. When ventilation was apneic the relationship was log-log. Within the thermoneutral zone ventilation frequency was not significantly different from that predicted from allometric equations for a terrestrial mammal of equivalent body mass, but was significantly greater than that predicted for a bird. A reduction in the amount of oxygen consumed per breath occurred at ambient temperatures above the upper critical temperature (39°C).

Changing listening frequency to minimise white noise and hear indigenous voices

Listening… can involve the listener in an intense, efficacious, and complex set of communicative acts in which one is not speaking, discussing, or disclosing, but sitting quietly, watching, and feeling-the-place, through all the senses…. In the process, one becomes a part of the scene, hearing and feeling with it (Carbaugh 1999: 259).To listen this way involves much more than providing a chance for words to be spoken; it includes tuning in and getting the listening frequency clear. As a non-Indigenous person seeking to conduct qualitative research that listens to Aboriginal people, I need to ask how I can tune into the “active attentiveness” described by Carbaugh (1999) in order to listen in a manner that is appropriate, respectful and minimises my inherent white privilege. In addressing this question I draw on the work of Indigenous authors and academics, critical whiteness studies and my own experiences learning from Aboriginal people in a number of contexts over the past ten to fifteen years.History in Australia since colonization has created a situation where Aboriginal voices are white noise to the ears of many non-Indigenous people. This paper proposes that white privilege and the resulting white noise can be minimised and greater clarity given to Aboriginal voices by privileging Indigenous knowledge and ways of working when addressing Indigenous issues. To minimise the interference of white noise, non-Indigenous people would do well to adopt a position that recognises, acknowledges and utilises some of the strengths that can be learned from Aboriginal culture and Indigenous authors.This paper outlines a model of apprentice, allied listening for non-Indigenous researchers to adopt when preparing to conduct research alongside Indigenous people. Such an approach involves Re-learning of history, Reviewing of the researcher’s beliefs and placing Relating at the centre of the listening approach. Each of these aspects of listening is based on privileging of Indigenous voices.

Family centred care before and during life-sustaining treatment withdrawal in intensive care: a survey of information provided to families by Australasian critical care nurses

BACKGROUND: A core component of family-centred nursing care during the provision of end-of-life care in intensive care settings is information sharing with families. Yet little is known about information provided in these circumstances.

OBJECTIVE: To identify information most frequently given by critical care nurses to families in preparation for and during withdrawal of life-sustaining treatment.

DESIGN: An online cross-sectional survey.

METHODS: During May 2015, critical care nurses in Australia and New Zealand were invited to complete the Preparing Families for Treatment Withdrawal questionnaire. Data analysis included descriptive statistics to identify areas of information most and least frequently shared with families. Cross tabulations with demographic data were used to explore any associations in the data.

RESULTS: From the responses of 159 critical care nurses, information related to the emotional care and support of the family was most frequently provided to families in preparation for and during withdrawal of life-sustaining treatment. Variation was noted in the frequency of provision of information across body systems and their associated physical changes during the dying process. Significant associations (p<0.05) were identified between the variables gender, nursing experience and critical care experiences and some of the information items most and least frequently provided.

CONCLUSIONS: The provision of information during end-of-life care reflects a family-centred care approach by critical care nurses with information pertaining to emotional care and support of the family paramount. The findings of this study provide a useful framework for the development of interventions to improve practice and support nurses in communicating with families at this time.