The impact of a model of nurse education to improve knowledge and recognition of delirium in older persons by registered nurses

Introduction: Delirium is a serious issue associated with high morbidity and mortality in older hospitalised people. Early recognition enables diagnosis and treatment of underlying cause/s, which can lead to improved patient outcomes. However, research shows knowledge and accurate nurse recognition of delirium and is poor and lack of education appears to be a key issue related to this problem. Thus, the purpose of this randomised controlled trial (RCT) was to evaluate, in a sample of registered nurses, the usability and effectiveness of a web-based learning site, designed using constructivist learning principles, to improve acute care nurse knowledge and recognition of delirium. Prior to undertaking the RCT preliminary phases involving; validation of vignettes, video-taping five of the validated vignettes, website development and pilot testing were completed. Methods: The cluster RCT involved consenting registered nurse participants (N = 175) from twelve clinical areas within three acute health care facilities in Queensland, Australia. Data were collected through a variety of measures and instruments. Primary outcomes were improved ability of nurses to recognise delirium using written validated vignettes and improved knowledge of delirium using a delirium knowledge questionnaire. The secondary outcomes were aimed at determining nurse satisfaction and usability of the website. Primary outcome measures were taken at baseline (T1), directly after the intervention (T2) and two months later (T3). The secondary outcomes were measured at T2 by participants in the intervention group. Following baseline data collection remaining participants were assigned to either the intervention (n=75) or control (n=72) group. Participants in the intervention group were given access to the learning intervention while the control group continued to work in their clinical area and at that time, did not receive access to the learning intervention. Data from the primary outcome measures were examined in mixed model analyses. Results: Overall, the effect of the online learning intervention over time comparing the intervention group and the control group were positive. The intervention groups‘ scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for delirium recognition when comparing T2 and T1 results (t=2.58 p=0.012) between the control and intervention group but not for changes in delirium recognition scores between the two groups from T3 and T1 (t=1.80 p=0.074). The majority of the participants rated the website highly on the visual, functional and content elements. Additionally, nearly 80% of the participants liked the overall website features and there were self-reported improvements in delirium knowledge and recognition by the registered nurses in the intervention group. Discussion: Findings from this study support the concept that online learning is an effective and satisfying method of information delivery. Embedded within a constructivist learning environment the site produced a high level of satisfaction and usability for the registered nurse end-users. Additionally, the results showed that the website significantly improved delirium knowledge & recognition scores and the improvement in delirium knowledge was retained at a two month follow-up. Given the strong effect of the intervention the online delirium intervention should be utilised as a way of providing information to registered nurses. It is envisaged that this knowledge would lead to improved recognition of delirium as well as improvement in patient outcomes however; translation of this knowledge attainment into clinical practice was outside the scope of this study. A critical next step is demonstrating the effect of the intervention in changing clinical behaviour, and improving patient health outcomes.

Evaluation of implementation of a healthy food and drink supply strategy throughout the whole school environment in Queensland state schools, Australia

BACKGROUND/OBJECTIVES: This paper reports on the evaluation of the Smart Choices healthy food and drink supply strategy for Queensland schools (Smart Choices) implementation across the whole school environment in state government primary and secondary schools in Queensland, Australia. SUBJECTS/METHODS: Three concurrent surveys using different methods for each group of stakeholders that targeted all 1275 school Principals, all 1258 Parent and Citizens’ Associations (P&Cs) and a random sample of 526 tuckshop convenors throughout Queensland. Nine hundred and seventy-three Principals, 598 P&Cs and 513 tuckshop convenors participated with response rates of 78%, 48% and 98%, respectively. RESULTS: Nearly all Principals (97%), P&Cs (99%) and tuckshop convenors (97%) reported that their school tuckshop had implemented Smart Choices. The majority of Principals and P&Cs reported implementation, respectively, in: school breakfast programs (98 and 92%); vending machine stock (94 and 83%); vending machine advertising (85 and 84%); school events (87 and 88%); school sporting events (81 and 80%); sponsorship and advertising (93 and 84%); fundraising events (80 and 84%); and sporting clubs (73 and 75%). Implementation in curriculum activities, classroom rewards and class parties was reported, respectively, by 97%, 86% and 75% of Principals. Respondents also reported very high levels of understanding of Smart Choices and engagement of the school community. CONCLUSIONS: The results demonstrated that food supply interventions to promote nutrition across all domains of the school environment can be implemented successfully.

Innovative Products Focus Group Report 2012. Brisbane: QUT

This report presents the results of Phase 3 of the Innovative Road Products Project: National Focus Groups. The groups developed solutions to address the most important obstacles constraining the adoption of innovative products in Australian road construction projects. The Innovative Products Survey, the major Project deliverable in 2011, and the largest innovation survey ever undertaken in the Australian road consutrction industry, results in the identification of key obstacles constraining the adoption of innovative products on road projects.

Use of focus group technique to investigate infection control practice

Use of focus groups as a technique of inquiry is gaining attention in the area of health-care research. This paper will report on the technique of focus group interviewing to investigate the role of the infection control practitioner. Infection control is examined as a specialty area of health-care practice that has received little research attention to date. Additionally, it is an area of practice that is expanding in response to social, economic and microbiological forces. The focus group technique in this study helped a group of infection control practitioners from urban, regional and rural areas throughout Queensland identify and categorise their daily work activities. The outcomes of this process were then analysed to identify the growth in breadth and complexity of the role of the infection control practitioner in the contemporary health-care environment. Findings indicate that the role of the infection control practitioner in Australia has undergone changes consistent with and reflecting changing models of health-care delivery.

Dichotomy in the design studio : adapting to new blended learning environments

Since the architectural design studio learning environment was first established in the early 19th century at the École des Beaux-Arts in Paris, there has been a complete transformation in how the discipline of architecture is practiced and how students of architecture acquire information. Digital technologies allow students to access information instantly and learning is no longer confined to the rigid boundaries of a physical campus environment. In many schools of architecture in Australia, the physical design studio learning environments however, remain largely unchanged. Many learning environments could be mistaken for those last refurbished 30 years ago, being devoid of any significant technological intervention. While some teaching staff are eagerly embracing new digital technologies and attempting to modify their pedagogical approaches, the physical design studio learning environment is resistant to such efforts. In a study aimed at better understanding how staff and students adapt to new blended learning environments, a group of 165 second year architecture students at a large school of architecture in Australia were separated into two different design studio learning environments. 70% of students were allocated to a traditional design studio setting and 30% to a new, high technology embedded, prototype digital learning laboratory. The digital learning laboratory was purpose designed for the case-study users, adapted Student-Centred Active Learning Environment for Undergraduate Programs [SCALE-UP] principles, and built as part of a larger university research project. The architecture students attended the same lectures, followed the same studio curriculum and completed the same pieces of assessment; the only major differences were the teaching staff and physical environment within which the studios were conducted. At the end of the semester, all staff and students were asked to complete a questionnaire about their experiences and preferences within the two respective learning environments. The questionnaire response rate represented the opinions of 100% of the 10 teaching staff and over 70% of the students. Using a qualitative grounded theory approach, data were coded, extrapolated and compared, to reveal emerging key themes. The key themes formed the basis for in-depth interviews and focus groups of teaching staff and students, allowing the researchers to understand the data in more detail. The results of the data verified what had become increasingly evident during the course of the semester: an underlying negative resistance to the new digital studio learning environment, by both staff and students. Many participants openly exhibited a yearning for a return to the traditional design studio learning environments, particularly when the new technology caused frustration, by being unreliable or failing altogether. This paper reports on the study, discusses the negative resistance and explores the major contributors to resistance. The researchers are not aware of any similar previous studies across these particular settings and believe that it offers a necessary and important contribution to emergent research about adaptation to new digital learning environments.

Preliminary reliability and validity testing of a self-efficacy questionnaire for Chinese family caregivers

Objectives: To develop and test preliminary reliability and validity of a Self-Efficacy Questionnaire for Chinese Family Caregivers (SEQCFC). Methods: A cross-sectional survey of 196 family caregivers (CGs) of people with dementia (CGs) was conducted to determine the factor structure of a SEQCFC of people with dementia. Following factor analyses, preliminary testing was performed, including internal consistency, 4-week test retest reliability, and construct and convergent validity. Results: Factor analyses with direct oblimin rotation were performed. Eight items were removed and five subscales(selfefficacy for gathering information about treatment, symptoms and health care; obtaining support; responding to behaviour disturbances; managing household, personal and medical care; and managing distress associated with caregiving) were identified. The Cronbach’s alpha coefficients for the whole scale and for each subscale were all over 0.80. The 4-week testretest reliabilities for the whole scale and for each subscale ranged from 0.64 to 0.85. The convergent validity was acceptable. Conclusions: Evidence for the preliminary testing of the SEQCFC was encouraging. A future follow-up study using confirmatory factor analysis with a new sample from different recruitment centres in Shanghai will be conducted. Future psychometric property testings of the questionnaire will be required for CGs from other regions of mainland China.

The strategic importance of tacit knowledge management activities in construction

Purpose: Tacit knowledge is perceived as the most strategically important resource of the construction organisation, and the only renewable and sustainable base for its activities and competitiveness. Knowledge management (KM) activities that deal with tacit knowledge are essential in helping an organisation to achieve its long-term organisational objectives. The purpose of this paper is to provide empirical evidence for the stronger strategic role of tacit KM in comparison to explicit KM. Design/methodology/approach: A questionnaire survey was administered in 2005 to a sample of construction contractors operating in Hong Kong to elicit opinions on the internal business environment, intensity of KM activities as executed by targeted organisations, and contribution of these activities to business performance (BP). A total of 149 usable responses were received from 99 organisations representing about 38 per cent of the sampling frame. The statistical analyses helped to map the reported KM activities into two groups that, respectively, deal with tacit and explicit knowledge. The sensitivity to variations of organisational policies and strength of association with BP in relation to the two groups of KM activities were also compared empirically. A total of 15 interviews with the managerial and professional staff of leading contractors was undertaken to provide insightful narratives of KM implementations. Findings: The effective implementation of organisational policies, such as encouraging innovations and strengthening strategic guidance for KM, would facilitate human interactions of tacit KM. Higher intensity of activities in managing tacit knowledge would ultimately help the organisations to achieve economic gain in the long run. Originality/value: The stronger strategic role of tacit KM is empirically investigated and established within the context of construction organisations.

Identifying key enablers to improve business performance in Taiwanese electronic manufacturing companies

Purpose – Integrated supplier management (ISM), new product development (NPD) and knowledge sharing (KS) practices are three primary business activities utilised to enhance manufacturers' business performance (BP). The purpose of this paper is to empirically investigate the relationships between these three business activities (i.e. ISM, NPD, KS) and BP in a Taiwanese electronics manufacturing context. Design/methodology/approach – A questionnaire survey is first administered to a sample of electronic manufacturing companies operating in Taiwan to elicit the opinions of technical and managerial professionals regarding business activities and BP within their companies. A total of 170 respondents from 83 companies respond to the survey. Factor, correlation and path analysis are undertaken on this quantitative data set to derive the key factors which leverage business outcomes in these companies. Following empirical analysis, six semi-structured interviews are undertaken with manufacturing executives to provide qualitative insights into the underlying reasons why certain business activity factors are the strongest predictors of BP. Findings – The investigation shows that the ISM, NPD and KS constructs all play an important role in the success of company operations and creating business outcomes. Specifically, the key factors within these constructs which influenced BP are: supplier evaluation and selection; design simplification and modular design; information technology infrastructure and systems and open communication. Accordingly, sufficient financial and human resources should be allocated to these important activities to derive accelerated rates of improved BP. These findings are supported by the qualitative interviews with manufacturing executives. Originality/value – The paper depicts the pathways to improved manufacturing BP, through targeting efforts into the above-mentioned factors within the ISM, NPD and KS constructs. Based on the empirical path model, and the specific insights derived from the explanatory interviews with manufacturing executives, the paper also provides a number of practical implications for manufacturing companies seeking to enhance their BP through improved operational activities.

Contribution of knowledge management activities to organisational business performance

Purpose – Within the construction industry there is a growing awareness of the need for linking knowledge management (KM) to business strategy, organisational objectives and existing performance measures. This study was undertaken within the context of construction organisations, and attempts to provide the empirical evidence about the relationships between KM activities and organisational business performance. Design/methodology/approach – A questionnaire survey was administered to a sample of construction contractors operating in Hong Kong to investigate the opinions of construction professionals regarding the intensity of KM activities and business performance within their organisations. In parallel to the survey, semi-structured interviews were undertaken to provide qualitative insights that helped to clarify and deepen understanding of the KM process within the context of the research target. Findings – The investigation shows that knowledge utilisation is the strongest contributor to general business performance. In addition, the impact of KM activities on the lagging performance indicators of the Balanced Scorecard (BSC), such as “financial performance”, is in an indirect manner, and through the leading indicators such as performance from “internal process” as well as “learning and growth” perspectives. Originality/value – The study empirically establishes the linkage between intensity of KM activities and business performance, and demonstrates that KM strategies need to be explicitly formulated and measured according to organisational business objectives.

Empirical study of interactions between knowledge management activities

Purpose – Recent knowledge management (KM) literature suggests that KM activities are not independent of each other, rather they interact with each other to form a process which receives input from both external and internal business environments, and then produces new knowledge for future utilisation. The purpose of this paper is to empirically investigate the relationships between KM activities within the construction business context in order to identify and map the pattern of their interactions. Design/methodology/approach – A questionnaire survey was administered to a sample of contracting organisations operating in Hong Kong to elicit opinions of construction professionals on the intensity of KM activities currently being executed by their organisations in order to facilitate knowledge capture, sharing and utilisation. More than 150 respondents from 99 organisations responded to the survey. Additionally, a total of 15 semi-structured interviews were undertaken to provide a unique perspective on many of the challenges facing local construction organisations when dealing with KM activities. Findings – Knowledge acquisition and utilisation play paramount roles in the development of the organisational knowledge asset. The higher the intensity of these two activities, the larger the organisational knowledge pool which, in turn, demands greater knowledge dissemination capacity. This dissemination capacity enables more active and intense responses to market changes and clients' needs, thus facilitating and stimulating acquisition and utilisation of new tacit knowledge, thus improving organisational business performance. Originality/value – Interactions between KM activities were empirically investigated, from a strategic perspective, in the construction business context.

Suicidal ideation and behaviours among university students in Australia

Objective: The aim of the study was to investigate the prevalence and demographic correlates of suicidal ideation and behaviours among university students in Australia and the utilisation of mental health services by this population. Method: Suicidal ideation and behaviours and demographic variables were assessed in a population of 1,678 undergraduate students by use of a modified Suicide Ideation Scale (SIS) and questionnaire. Results: Sixty two percent of students surveyed showed some suicidal ideation and 6.6% reported one or more suicide attempts. Over half of the group who reported suicide attempts did not use any type of mental health services. Suicidal ideation was found to be highly correlated with previous use of mental health services, In examining the relationship between suicidal ideation (SI) end demographic variables, SI was not significantly different for gender or parental marital status but was related to living arrangements, racial groups, religious affiliation and father's education. Conclusions: The results suggest that a higher proportion of students reported suicidal ideation and behaviours than that documented in related studies undertaken in the USA. While these findings draw attention to a higher level of suicidal ideation in students who utilise mental health assistance, more than half of those who reported suicide attempts did not use any kind of mental health service. The study has particular implications for detecting and assisting young people with a high suicide risk within the university environment.

‘The health-location connection’: using GIS and social media on smartphones to track engagement with the Local urban environment for work, recreation, and physical activity

A technologically innovative study was undertaken across two suburbs in Brisbane, Australia, to assess socioeconomic differences in women's use of the local environment for work, recreation, and physical activity. Mothers from high and low socioeconomic suburbs were instructed to continue with usual daily routines, and to use mobile phone applications (Facebook Places, Twitter, and Foursquare) on their mobile phones to ‘check-in’ at each location and destination they reached during a one-week period. These smartphone applications are able to track travel logistics via built-in geographical information systems (GIS), which record participants’ points of latitude and longitude at each destination they reach. Location data were downloaded to Google Earth and excel for analysis. Women provided additional qualitative data via text regarding the reasons and social contexts of their travel. We analysed 2183 ‘check-ins’ for 54 women in this pilot study to gain quantitative, qualitative, and spatial data on human-environment interactions. Data was gathered on distances travelled, mode of transport, reason for travel, social context of travel, and categorised in terms of physical activity type – walking, running, sports, gym, cycling, or playing in the park. We found that the women in both suburbs had similar daily routines with the exception of physical activity. We identified 15% of ‘check-ins’ in the lower socioeconomic group as qualifying for the physical activity category, compared with 23% in the higher socioeconomic group. This was explained by more daily walking for transport (1.7kms to 0.2kms) and less car travel each week (28.km to 48.4kms) in the higher socioeconomic suburb. We ascertained insights regarding the socio-cultural influences on these differences via additional qualitative data. We discuss the benefits and limitations of using new technologies and Google Earth with implications for informing future physical and social aspects of urban design, and health promotion in socioeconomically diverse cities.

Improving quality management system implementation in Indonesian construction companies

As the Indonesian construction industry is now promising to become the engine of national economic development, achieving quality and higher performance, not only domestically but also in the international market, are becoming crucial issues. Implementing quality management systems (QMSs) based on ISO 9001 are important in helping Indonesian construction companies become more competitive, for it is acknowledged that quality in construction is a major concern in the global construction industry. However, the possession of ISO 9001 certification does not reflect the presence of a well-operated QMS, which is capable of giving customer and project end-users satisfaction. The review of literature found that there is a significant correlation between a company.s organisational culture and the quality performance of contractors. While research into this area has involved many researchers, there is no critical mass of information specifically related to the Indonesian situation. Studies based on contemporary perspectives of the characteristics of the Indonesian construction organisational culture using Cameron and Quinn.s Organizational Culture Assessment Instrument (OCAI) and its relationship with the contractor.s ISO 9001 practices, have not been previously undertaken. This thesis research, therefore, investigated the culture profiles in Indonesian construction organisations, together with the current implementation of ISO 9001 and their performance during implementing QMSs, as information in these areas has a bearing on the poor performance and low levels of competitiveness of Indonesian construction companies. Questionnaire surveys were distributed to selected representative grade 7 civil engineering contractors located in the two provincial capitals of Makassar and Manado, and the national capital, Jakarta, in order to collect responses designed to examine the effectiveness of their QMSs implementation. The survey also aimed to identify current problems within the systems, and examine the performance of companies while implementing their QMSs. The questionnaire contained questions to assess the organisational culture profiles of Indonesian construction companies, adopting the OCAI. The survey results were then used to analyse the influence of different organisational culture profiles on QMSs implementation among respondent companies. The results from the questionnaire survey supported the development of a Culture-based Quality Management System Improvement Implementation Framework, designed to help Indonesian construction companies identify some typical barriers associated with impacting on effective QMSs implementation; to assist them to develop cultural values that can drive effective QMSs implementation; to undertake effective QMSs practices; and to recognise the potential results and longer-term benefits obtainable from implementing effective QMSs. A Focus Group Discussion was conducted with the assistance of a panel of professional construction practitioners, policy makers and academic experts, which further considered and validated the usefulness and applicability of the framework. Based on the outcome from this discussion and on the results of the earlier data analysis, a final version of the framework was developed to assist Indonesian construction companies in improving their capability of construction project delivery, and thereby contribute to providing or improving the competitive advantage of Indonesian construction companies in the local, national and global construction market.

Empowering the school community for change : an evaluation of participation in the Ashgrove Healthy School Environment Project

The purpose of this study was to evaluate aspects of participation in a participatory action research project, the Ashgrove Healthy School Environment Project. Participatory action research is a form of research that creates change as an explicit part of the research process and requires the active participation of those by and for whom the research is being conducted. This study arose from concems by this researcher, who is also a co-facilitator of the project, that levels of participation were not as extensive as one might have hoped and that this seemingly low level would have a negative impact on the continuing participation of those already involved. Specifically. this evaluation sought to uncover the reasons that prompted participation, to identify structural barriers to initial involvement and to uncover participants' perceptions of the process, including barriers and opportunities. It also sought to record evidence of any shift in decision making and to draw implications about the findings that could assist the project, the school, other schools and the wider community. This evaluation involved focus group discussions and interviews with participants actively involved in the school project. The purpose was to uncover their views, feelings and perceptions about their participation and the participatory processes in use generally. It also included some examination of school documents and newsletters and as also drawn on the reflections of this 'insider' researcher, based on two years of involvement in facilitating the project. The findings that emerge from this study are heartening. Rather than feeling anxious about the long-term sustainability of the project, this researcher now feels more confident about its achievements, both in terms of the changes that have occurred in the school and about the participatory processes and levels of participation. Whilst the evaluation has identified a number of barriers, both institutional, personal and project related, it has also identified several key factors that serve to promote participation.

Investing for impact : Constructing a better built environment

This publication, Investing for Impact, is a key outcome of Project 2.7 Leveraging R&D Investment for the Australian Built Environment. This information will be included in a more comprehensive book being prepared for publication in 2014 (Taylor and Francis). It draws together research findings and case studies from CIB Task Group 85 members from across the globe, highlighting their diversity and similarities. The evaluation of international case studies on the role and impact of R&D on national development has allowed us to demonstrate examples from different sectors of the built environment of R&D investment models that provide return on investment and other benefits for companies, governments and the general community.