Effectiveness of nurse-led preoperative assessment services for elective surgery : a systematic review

Background--The admission and assessment of patients for elective procedures is a task faced by all healthcare organisations that provide elective surgical services. Several different strategies have been used to facilitate the management of these tasks. Nurse-led preadmission clinics or services have been implemented in many health services as one of these management strategies; however their effectiveness has not been established. Objectives--The objective of this review was to examine the available research on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes.--Results--Of the 19 included articles, there were 10 audits of patient and hospital data, 3 surveys or questionnaires, 3 descriptive studies, 1 action research design, 1 prospective observational study and 1 RCT. Five of ten studies reporting data on cancellations rates found that nurse-led preadmission services reduced the number of day-of-surgery cancellations. Non-attendance for surgery was also reduced, with nine studies reporting decreases in the number of patients failing to attend. Eight studies reporting data on patient or parent satisfaction found high levels of satisfaction with nurse-led preadmission services. Three of four studies investigating the effect of the nurse-led preadmission service on patient anxiety found a reduction in reported anxiety levels. Three studies found that preoperative preparation was enhanced by the use of a nurse-led preadmission service.--Conclusions--While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low, and further research is needed.--Implications for practice--Nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, and patient anxiety, however currently the evidence level is low.

Identification of factors contributing to recurrence of venous leg ulcers

Background and Significance Venous leg ulcers are a significant cause of chronic ill-health for 1–3% of those aged over 60 years, increasing in incidence with age. The condition is difficult and costly to heal, consuming 1–2.5% of total health budgets in developed countries and up to 50% of community nursing time. Unfortunately after healing, there is a recurrence rate of 60 to 70%, frequently within the first 12 months after heaing. Although some risk factors associated with higher recurrence rates have been identified (e.g. prolonged ulcer duration, deep vein thrombosis), in general there is limited evidence on treatments to effectively prevent recurrence. Patients are generally advised to undertake activities which aim to improve the impaired venous return (e.g. compression therapy, leg elevation, exercise). However, only compression therapy has some evidence to support its effectiveness in prevention and problems with adherence to this strategy are well documented. Aim The aim of this research was to identify factors associated with recurrence by determining relationships between recurrence and demographic factors, health, physical activity, psychosocial factors and self-care activities to prevent recurrence. Methods Two studies were undertaken: a retrospective study of participants diagnosed with a venous leg ulcer which healed 12 to 36 months prior to the study (n=122); and a prospective longitudinal study of participants recruited as their ulcer healed and data collected for 12 months following healing (n=80). Data were collected from medical records on demographics, medical history and ulcer history and treatments; and from self-report questionnaires on physical activity, nutrition, psychosocial measures, ulcer history, compression and other self-care activities. Follow-up data for the prospective study were collected every three months for 12 months after healing. For the retrospective study, a logistic regression model determined the independent influences of variables on recurrence. For the prospective study, median time to recurrence was calculated using the Kaplan-Meier method and a Cox proportional-hazards regression model was used to adjust for potential confounders and determine effects of preventive strategies and psychosocial factors on recurrence. Results In total, 68% of participants in the retrospective study and 44% of participants in the prospective study suffered a recurrence. After mutual adjustment for all variables in multivariable regression models, leg elevation, compression therapy, self efficacy and physical activity were found to be consistently related to recurrence in both studies. In the retrospective study, leg elevation, wearing Class 2 or 3 compression hosiery, the level of physical activity, cardiac disease and self efficacy scores remained significantly associated (p<0.05) with recurrence. The model was significant (p <0.001); with a R2 equivalent of 0.62. Examination of relationships between psychosocial factors and adherence to wearing compression hosiery found wearing compression hosiery was significantly positively associated with participants’ knowledge of the cause of their condition (p=0.002), higher self-efficacy scores (p=0.026) and lower depression scores (p=0.009). Analysis of data from the prospective study found there were 35 recurrences (44%) in the 12 months following healing and median time to recurrence was 27 weeks. After adjustment for potential confounders, a Cox proportional hazards regression model found that at least an hour/day of leg elevation, six or more days/week in Class 2 (20–25mmHg) or 3 (30–40mmHg) compression hosiery, higher social support scale scores and higher General Self-Efficacy scores remained significantly associated (p<0.05) with a lower risk of recurrence, while male gender and a history of DVT remained significant risk factors for recurrence. Overall the model was significant (p <0.001); with an R2 equivalent 0.72. Conclusions The high rates of recurrence found in the studies highlight the urgent need for further information in this area to support development of effective strategies for prevention. Overall, results indicate leg elevation, physical activity, compression hosiery and strategies to improve self-efficacy are likely to prevent recurrence. In addition, optimal management of depression and strategies to improve patient knowledge and self-efficacy may positively influence adherence to compression therapy. This research provides important information for development of strategies to prevent recurrence of venous leg ulcers, with the potential to improve health and decrease health care costs in this population.

Predicting the consumption of foods low in saturated fats among people diagnosed with Type 2 diabetes and cardiovascular disease. The role of planning in the theory of planned behaviour

The present study tested the utility of an extended version of the theory of planned behaviour that included a measure of planning, in the prediction of eating foods low in saturated fats among adults diagnosed with Type 2 diabetes and/or cardiovascular disease. Participants (N = 184) completed questionnaires assessing standard theory of planned behaviour measures (attitude, subjective norm, and perceived behavioural control) and the additional volitional variable of planning in relation to eating foods low in saturated fats. Self-report consumption of foods low insaturated fats was assessed 1 month later. In partial support of the theory of planned behaviour, results indicated that attitude and subjective norm predicted intentions to eat foods low in saturated fats and intentions and perceived behavioural control predicted the consumption of foods low in saturated fats. As an additional variable, planning predicted the consumption of foods low in saturated fats directly and also mediated the intention–behaviour and perceived behavioural control–behaviour relationships, suggesting an important role for planning as a post-intentional construct determining healthy eating choices. Suggestions are offered for interventions designed to improve adherence to healthy eating recommendations for people diagnosed with these chronic conditions with a specific emphasis on the steps and activities that are required to promote a healthier lifestyle.

The evaluation of qualitative methods selection in the field of design and emotion

The aim of this paper is to aid researchers in selecting appropriate qualitative methods in order to develop and improve future studies in the field of emotional design. These include observations, think-aloud protocols, questionnaires, diaries and interviews. Based on the authors’ experiences, it is proposed that the methods under review can be successfully used for collecting data on emotional responses to evaluate user product relationships. This paper reviews the methods; discusses the suitability, advantages and challenges in relation to design and emotion studies. Furthermore, the paper outlines the potential impact of technology on the application of these methods, discusses the implications of these methods for emotion research and concludes with recommendations for future work in this area.

Multitasking information behaviour in public libraries : a survey study

Multitasking information behaviour is the human ability to handle the demands of multiple information tasks concurrently. When we multitask, we work on two or more tasks and switch between those tasks. Multitasking is the way most of us deal with the complex environment we all live in, and recent studies show that people often engage in multitasking information behaviours. Multitasking information behaviours are little understood, however, and an important area for information behaviour research. Our study investigated the multitasking information behaviours of public library users at the Brentwood and Wilkinsburg Public Libraries in Pittsburgh through diary questionnaires. Findings include that some 63.5 percent of library users engaged in multitasking information behaviours, with a mean of 2.5 topic changes and 2.8 topics per library visit. A major finding of our study is that many people in libraries are seeking information on multiple topics and are engaged in multitasking behaviours. The implications of our findings and further research are also discussed. (Contains 7 tables and 2 figures.)

The nature of caregiving in children of a parent with multiple sclerosis from multiple sources and the associations between caregiving activities and youth adjustment overtime

This study explored youth caregiving for a parent with multiple sclerosis (MS) from multiple perspectives, and examined associations between caregiving and child negative (behavioural emotional difficulties, somatisation) and positive (life satisfaction, positive affect, prosocial behaviour) adjustment outcomes overtime. A total of 88 families participated; 85 parents with MS, 55 partners and 130 children completed questionnaires at Time 1. Child caregiving was assessed by the Youth Activities of Caregiving Scale (YACS). Child and parent questionnaire data were collected at Time 1 and child data were collected 12 months later (Time 2). Factor analysis of the child and parent YACS data replicated the four factors (instrumental, social-emotional, personal-intimate, domestic-household care), all of which were psychometrically sound. The YACS factors were related to parental illness and caregiving context variables that reflected increased caregiving demands. The Time 1 instrumental and social-emotional care domains were associated with poorer Time 2 adjustment, whereas personal-intimate was related to better adjustment and domestic-household care was unrelated to adjustment. Children and their parents exhibited highest agreement on personal-intimate, instrumental and total caregiving, and least on domestic-household and social-emotional care. Findings delineate the key dimensions of young caregiving in MS and the differential links between caregiving activities and youth adjustment.

Survey of novice motorcycle riders and their riding experience before licensing

Graduated licensing schemes have been found to reduce the crash risk of young novice drivers, but there is less evidence of their success with novice motorcycle riders. This study examined the riding experience of a sample of Australian learner-riders to establish the extent and variety of their riding practice during the learner stage. Riders completed an anonymous questionnaire at a compulsory rider-training course for the licensing test. The majority of participants were male (81%) with an average age of 33 years. They worked full time (81%), held an unrestricted driver's license (81%), and owned the motorcycle that they rode (79%). These riders had held their learner's license for an average of 6 months. On average, they rode 6.4 h/week. By the time they attempted the rider-licensing test, they had ridden a total of 101 h. Their total hours of on-road practice were comparable to those of learner-drivers at the same stage of licensing, but they had less experience in adverse or challenging road conditions. A substantial proportion had little or no experience of riding in the rain (57%), at night (36%), in heavy traffic (22%), on winding rural roads (52%), or on high-speed roads (51%). These findings highlight the differences in the learning processes between unsupervised novice motorcycle riders and supervised novice drivers. Further research is necessary to clarify whether specifying the conditions under which riders should practice during the graduated licensing process would likely reduce or increase their crash risk.

Diversity management for innovation in social enterprises in the UK

This paper examines the linkages between diversity management (DM), innovation and high performance in social enterprises. These linkages are explicated beyond traditional framing of DM limited to workforce composition, to include discussions of innovation through networked diversity practices; reconciliation; and funding options. The paper draws upon a UK-based national survey and the case study data. Multiple data collection methods were used, including semi-structured interviews, questionnaires and workshops with participant observation. NVivo and SPSS software packages were utilized in order to analyse the qualitative and quantitative data, respectively. We used thematic coding and cropping techniques in analysing the case studies in the paper. A broad range of conflicting and supporting literature was enfolded into the conversations and discussion. The paper demonstrates that social enterprises exhibit unique characteristics in terms of size and location, as well as their double remit to add value both economically and socially. As a conclusion, we argue for social enterprises to consider options for DM in the interests of maximization of innovation and business performance. We contend that further research is needed to describe how social entrepreneurs draw upon their various ‘diversity resources’ in the process of innovation

The effectiveness of a short-term group music therapy intervention for parents who have a child with a disability

Background The relationship between positive parent-child interactions and optimal child development is well established. Families with a child with a disability may face additional challenges to establishing positive parent-child relationships. There are limited studies addressing the effectiveness of interventions which seek to address these issues with parents and young children with a disability. In particular, prior studies of music therapy with this group have been limited by small sample sizes and the use of measures of limited reliability and validity. Objective This study investigates the effectiveness of a short-term group music therapy intervention for parents who have a child with a disability and explores the factors associated with higher outcomes for participating families. Methods The participants were 201 mother-child dyads, where the child had a disability. Pre and post intervention parental questionnaires and clinician observation measures were taken on a range of parental wellbeing, parenting behaviours and child developmental factors. Descriptive data, t-tests for repeated measures and a predictive model tested via logistic regression are presented. Results Significant improvements pre to post were found for parent mental health, child communication and social skills, parenting sensitivity, parental engagement with child and acceptance of child, child responsiveness to parent, and child interest and participation in program activities. There was also evidence that parents were very satisfied with the program and that it brought social benefits to families. Reliable change on six or more indicators of parent or child functioning was predicted by attendance and parent education. Conclusions This study provides positive evidence for the effectiveness of group music therapy in promoting improved parental mental health, positive parenting and key child developmental areas. Whilst several limitations are discussed, the study does address some of the gaps in the music therapy evidence base in this area.

Profiling outdoor leadership

This paper examines the role outdoor recreation and education plays in the development of generic leaders who have a positive relationship to the natural world. Three questionnaires (Multifactor Leadership Questionnaire - MLQ; the New Ecological Paradigm Scale - NEP; and the Connectedness to Nature Scale - CNS) were administered online to 104 international outdoor leaders through five online networks. The three instruments assessed the nexus of transformational leadership theory and outdoor leadership. A descriptive analysis of early findings from the project are outlined in this paper. The results can be viewed as an appropriate platform for understanding outdoor recreation and education leaders’ ecological perspectives and the generic, transformational leadership skills.

Procuring Sydney’s Olympic Stadium : a world class event?

This paper describes and analyses the procurement processes employed in delivering the Sydney Olympic Stadium – arguably the most significant stadia project in the region today. This current high profile project is discussed in terms of a case study into the procurement processes used. Interviews, personal site visits and questionnaires were used to obtain information on the procurement processes used and comments on their application to the project. The alternative procurement process used on this project—Design and Construction within a Build, Own, Operate and Transfer (BOOT) project—is likely to impact on the construction industry as a whole. Already other projects and sectors are following this lead. Based on a series of on-site interviews and questionnaires, a series of benefits and drawbacks to this procurement strategy are provided.The Olympic Stadium project has also been further analysed during construction through a Degree of Interaction framework to determine anticipated project success. This analysis investigates project interaction and user satisfaction to provide a comparable rating. A series of questionnaires were used to collect data to calculate the Degree of Interaction and User Satisfaction ratings.

Teachers’ and parents’ perspectives of digital technology in the lives of young children

The pervasiveness of technology in the 21st Century has meant that adults and children live in a society where digital devices are integral to their everyday lives and participation in society. How we communicate, learn, work, entertain ourselves, and even shop is influenced by technology. Therefore, before children begin school they are potentially exposed to a range of learning opportunities mediated by digital devices. These devices include microwaves, mobile phones, computers, and console games such as Playstations® and iPods®. In Queensland preparatory classrooms and in the homes of these children, teachers and parents support and scaffold young children’s experiences, providing them with access to a range of tools that promote learning and provide entertainment. This paper examines teachers’ and parents’ perspectives and considers whether they are techno-optimists who advocate for and promote the inclusion of digital technology, or whether they are they techno-pessimists, who prefer to exclude digital devices from young children’s everyday experiences. An exploratory, single case study design was utilised to gather data from three teachers and ten parents of children in the preparatory year. Teacher data was collected through interviews and email correspondence. Parent data was collected from questionnaires and focus groups. All parents who responded to the research invitation were mothers. The results of data analysis identified a misalignment among adults’ perspectives. Teachers were identified as techno-optimists and parents were identified as techno-pessimists with further emergent themes particular to each category being established. This is concerning because both teachers and mothers influence young children’s experiences and numeracy knowledge, thus, a shared understanding and a common commitment to supporting young children’s use of technology would be beneficial. Further research must investigate fathers’ perspectives of digital devices and the beneficial and detrimental roles that a range of digital devices, tools, and entertainment gadgets play in 21st Century children’s lives.

The development of the extended adolescent injury checklist (E-AIC) : a measure for injury prevention program evaluation

The Extended Adolescent Injury Checklist (E-AIC), a self-report measure of injury based on the model of the Adolescent Injury Checklist (AIC), was developed for use in the evaluation of school-based interventions. The three stages of this development involved focus groups with adolescents and consultations with medical staff, pilot testing of the revised AIC in a high school context, and use of the finalised checklist in pre- and post-questionnaires to examine its utility. Results revealed that responses to the final version of the E-AIC were meaningful and remained consistent over time. The E-AIC appears to be a promising measure of adolescent injury that is simple, time-efficient and appropriate for use in the evaluation of school-based injury prevention programs.

Ecological leadership : a new perspective on leadership

Given today's focus on the state of the environment and the developing role of corporate social leadership in could be argued that there is a need for the development of successful business leaders who have a positive relationship to the natural world. Gifford (2007) argued that any real change in sustainable practice will most likely happen at an individual level, through changes in attitudes and everyday behaviour. For this change to happen, an individual will need to feel connected to the natural world (Dunbar, 2004; Schroll, 2007). Roszak (1992) developed the notion of ecopsychology specifically to explore this relationship and suggest new ways to generate greater environmental awareness as well as ameliorate psychological problems caused or exacerbated by widespread alienation from nature. From this perspective it seems imperative that we develop people centred leader’s who feel connected to the natural world whilst demonstrating solid performance, as measured by organisational and social indicators. This paper presents information from an International research project that might add further insights into the role outdoor education plays in the development of generic leaders who have a positive relationship to the natural world. Three questionnaires, an established measurement of generic transformational leadership (MLQ) and two established measurement of attitudes to and feelings about the natural world (the New Ecological Paradigm Scale and the Connectedness to Nature Scale), were administered to 214 (males, n=138 and females, n=76) International outdoor leaders with the implicit aim of assessing the nexus of transformational leadership theory and adventure based leadership development. The large and diverse cohort of participants has provided ground-breaking insights into transformational and ecological leadership styles. This paper outlines a descriptive analysis of findings and offers valuable information for those involved in training leaders. Throughout this presentation participants will be encouraged to contextualise the information for their specific circumstance.

Working time alterations within the Australian construction industry

Purpose: The purpose of this paper is to provide a labour process theory interpretation of four case studies within the Australian construction industry. In each case study a working time intervention (a shift to a five-day working week from the industry standard six days) was implemented as an attempt to improve the work-life balance of employees. ----- ----- Design/methodology/approach: This paper was based on four case studies with mixed methods. Each case study has a variety of data collection methods which include questionnaires, short and long interviews, and focus groups. ----- ----- Findings: It was found that the complex mix of wage- and salary-earning staff within the construction industry, along with labour market pressures, means that changing to a five-day working week is quite a radical notion within the industry. However, there are some organisations willing to explore opportunities for change with mixed experiences. ----- ----- Practical implications: The practical implications of this research include understanding the complexity within the Australian construction industry, based around hours of work and pay systems. Decision-makers within the construction industry must recognize a range of competing pressures that mean that “preferred” managerial styles might not be appropriate. ----- ----- Originality/value:– This paper shows that construction firms must take an active approach to reducing the culture of long working hours. This can only be achieved by addressing issues of project timelines and budgets and assuring that take-home pay is not reliant on long hours of overtime.