Designing care bundle documentation to support the recognition and treatment of acute kidney injury: a route to quality improvement

The chapter describes development of care bundle documentation, through an iterative, user-centred design process, to support the recognition and treatment of acute kidney injury (AKI). The chapter details stages of user and stakeholder consultation, employed to develop a design response that was sensitive to user experience and need, culminating in simulation testing of a near final prototype. The development of supplementary awareness-raising materials, relating to the main care bundle tool is also discussed. This information design response to a complex clinical decision-making process is contrasted to other approaches to promoting AKI care. The need for different but related approaches to the working tool itself and the tool’s communication are discussed. More general recommendations are made for the development of communication tools to support complex clinical processes.

Is the unfolding of the group discussion off-pattern? Improving coordination support in educational forums using mobile devices

A forum is a valuable tool to foster reflection in an in-depth discussion; however, it forces the course mediator to continually pay close attention in order to coordinate learners` activities. Moreover, monitoring a forum is time consuming given that it is impossible to know in advance when new messages are going to be posted. Additionally, a forum may be inactive for a long period and suddenly receive a burst of messages forcing forum mediators to frequently log on in order to know how the discussion is unfolding to intervene whenever it is necessary. Mediators also need to deal with a large amount of messages to identify off-pattern situations. This work presents a piece of action research that investigates how to improve coordination support in a forum using mobile devices for mitigating mediator`s difficulties in following the status of a forum. Based on summarized information extracted from message meta-data, mediators consult visual information summaries on PDAs and receive textual notifications in their mobile phone. This investigation revealed that mediators used the mobile-based coordination support to keep informed on what is taking place within the forum without the need to log on their desktop computer. (C) 2009 Elsevier Ltd. All rights reserved.

Can qualitative methods support the development of more flexible and energy saving thermal comfort?

This paper uses examples from a Swedish study to suggest some ways in which cultural variation could be included in studies of thermal comfort. It is shown how only a slight shift of focus and methodological approach could help us discover aspects of human life that add to previous knowledge within comfort research of how human beings perceive and handle warmth and cold. It is concluded that it is not enough for buildings, heating systems and thermal control devices to be energy-efficient in a mere technical sense. If these are to help to decrease, rather than to increase, energy consumption, they have to support those parts of already existing habits and modes of thought that have the potential for low energy use. This is one reason why culture-specific features and emotional cores need to be investigated and deployed into the study and development of thermal comfort.

Parenthood in transition : Somali-born parents' experiences of and needs for parenting support programmes

BACKGROUND: Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting. METHODS: A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied. RESULTS: A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their parenting was described, which includes how to improve their communication and relationship with their children. The parents described a need for information on how to culturally adapt their parenting and obtain support from the authorities. CONCLUSIONS: Parents experienced a process of parenthood in transition. They were looking to the future and for ways to improve their parenting. Schools and social services can overcome barriers that prevent lack of knowledge about the new country's systems related to parenthood. Leaving the home country often means separation from the family and losing the social network. We suggest that staff in schools and social services offer parent training classes for these parents throughout their children's childhood, with benefits for the child and family.

Barriers in providing psychosocial support for patients with cancer

There is sound evidence to support the notion that the provision of effective psychosocial care improves the outcomes of patients with cancer. Central to the implementation of this care is that health professionals have the necessary communication and assessment skills. This study aimed to identify key issues related to providing effective psychosocial care for adult patients admitted with hematological cancer, as perceived by registered nurses with 3 or more years of clinical experience. An exploratory qualitative design was used for this study. Two focus group interviews were conducted with 15 experienced cancer nurses. The provision of psychosocial care for patients with cancer is a dynamic process that has a professional and personal impact on the nurse. The 5 analytic themes to emerge from the data were as follows: When is it a good time to talk? Building relationships; Being drawn into the emotional world; Providing support throughout the patient's journey; and Breakdown in communication processes. The findings from this study indicate an urgent need to develop a framework to provide nurses with both skill development and ongoing support in order to improve nurses' ability to integrate psychosocial aspects of care and optimize patient outcomes.

Fine motor difficulties: the need for advocating for the role of occupational therapy in schools

Background: Fine motor difficulties can impact on the academic, social and emotional development of a student. Aim: The aims of this paper are to: (i) investigate the need for support to students experiencing fine motor  difficulties from the perspective of their classroom teachers, and (ii) report on the level of knowledge teachers have in regard to the role of occupational therapists in supporting students with fine motor difficulties.  Methods: Fifteen teachers from a stratified random sample of public schools within two regions of Victoria, Australia, were interviewed in this qualitative, grounded theory investigation. Results: Results showed that the current level of support for students with fine motor difficulties is inadequate. Conclusion: Occupational therapists in Victoria need to advocate their role in developing the fine motor skills of students at both an organisational and an individual level in order to increase the access of students with fine motor difficulties to occupational therapy services.

Enabling successful web-based information technology support for enterprise customers: a service provider perspective of stakeholder-based issues

An understanding by support organisations of the key factors enabling successful enterprise after-sales customer support provision when using Web-based Selfservice Systems (WSSs) is essential to making  improvements in such systems. This paper reports key stakeholder-oriented findings from an interpretive study of critical success factors (CSFs) for the transfer of after-sales support-oriented knowledge from an information technology (IT) service provider to enterprise customers when a WSS is used. The findings suggest that researchers and practitioners should consider WSSs within a complex network of service providers, business partners and customer firms. The paper also clearly points to a need for support organisations to engage in greater collaboration and integration of WSSs with enterprise customers and business partners.

CHD and stroke : Scotland`s pandemics also need co-ordinated and vigorous primary prevention programmes

Further reductions in the incidence and mortality from CHD and stroke in Scotland will be largely dependent upon changes in the three major risk factors – cholesterol, blood pressure and smoking. Vigorous and co-ordinated primary prevention programmes are therefore required. This paper outlines the main elements of such a prevention programme starting in the Scottish Borders. It considers the three major risk factors and discusses local action within high risk groups and within the population at large for each. The importance of considering environmental changes and social supports for change are emphasised, and because of this, the key role of local authorities and other local partners. Suggestions for action at the national level to encourage and support the growth of such programmes across Scotland are given.

Small-scale randomized controlled trials need more powerful methods of mediational analysis than the Baron-Kenny method

Objective: To devise more-effective physical activity interventions, the mediating mechanisms yielding behavioral change need to be identified. The Baron–Kenny method is most commonly used, but has low statistical power and may not identify mechanisms of behavioral change in small-to-medium size studies. More powerful statistical tests are available.
Study Design and Setting: Inactive adults (N = 52) were randomized to either a print or a print-plus-telephone intervention. Walking and exercise-related social support were assessed at baseline, after the intervention, and 4 weeks later. The Baron–Kenny and three alternative methods of mediational analysis (Freedman–Schatzkin; MacKinnon et al.; bootstrap method) were used to examine the effects of social support on initial behavior change and maintenance. Results: A significant mediational effect of social support on initial behavior change was indicated by the MacKinnon et al., bootstrap, and, marginally, Freedman–Schatzkin methods, but not by the Baron–Kenny method. No significant mediational effect of social support on maintenance of walking was found. Conclusions:  Methodologically rigorous intervention studies to identify mediators of change in physical activity are costly and labor ntensive, and may not be feasible with large samples. The use of statistically powerful tests of mediational effects in small-scale studies can inform the development of more effective interventions.

Sibling peer support group for young people with a sibling using drugs: a pilot study

Siblings of young people abusing drugs are at particular risk for drug abuse and other health compromising behaviors. A Sibling Peer Support Group was developed by the Centre for Adolescent Health (Melbourne, Australia) for young people aged 13 to 18 years with a problematic drug user in their family. Groups aimed to provide support and information, promote harm minimization, and reduce the sense of isolation. The project emanated from the recognized need for specific support for adolescent siblings of problematic drug users. Evaluation of two pilot groups indicated positive benefits for group members, who reported feeling better informed, more supported, and having a reduced sense of isolation. Parents reported that their adolescent attending the group demonstrated improved communication with, and greater understanding and tolerance of, the family member using drugs. Promising indicators at a community level were manifested in enthusiastic collaboration among schools, police and local service agencies, and the organization of a local drug forum. There appeared to be little evidence that the groups inadvertently encouraged drug use. Recruitment of young people into groups was the major challenge for the project, but among drug and alcohol and family organizations there was support for the concept of a Sibling Peer Support Group. A new model to overcome the challenge of recruitment is proposed.

Breaking the boundaries : improving the assessibility, extent and responsiveness of support services for distance education students

Massey University, in common with other tertiary distance education providers, faces the challenge of improving the accessibility, extent and responsiveness of the support services it provides to extramural students. In particular, the university is challenged by the need to develop and deliver support services responsive to the changing needs of an increasingly diverse student population. This paper outlines the key findings of a comprehensive review of Massey’s support policy and services for extramural students. It describes how the review findings, and material from the body of literature on the provision of support for distance students, were used to inform the development of a new support policy for extramural students. How this policy is being made operational in practice, through the design, development and implementation of an extensive range of new student support services, including a range of services provided online, is outlined. A summary of progress made so far is provided. The paper concludes with some guidelines that may be useful in informing the practice of colleagues working to break the boundaries to student participation in support services.

Converged learning environment to support all learners

Universities face an uncertain future unless they significantly alter their teaching and learning approaches and become more client focused. They need to reach more and more students who do not fit the standard residential degree. This has meant that lecturers have had to facilitate learning for on-campus students on local and overseas campuses as well as for off-campus students based locally and globally. Given the context, flexibility has been recognised as a key idea making it imperative to explore innovative models for flexibility that bring together and accommodate and support all learner groups.

This paper describes a project to support students of an undergraduate Business Law unit via the development of such a converged learning environment. It attempts to draw together the different communities of students (on-campus and off-campus based locally and overseas) enrolled in that unit. In order to assist others interested in supporting flexible learning in a similar way, the paper shares details of formative evaluation and planned summative evaluation, together with reflections on lessons learned by the teaching academic and educational designer during its development process.

The need to accumlate human capital across levels of export intensity : activating resources that are increasingly difficult to mobilise

With increasing levels of export intensity, firms begin to face new demands. The first set of resources brought to bear on the issues, and those resources that are most quickly mobilised, are the employees. Indeed, higher levels of exporting require activating relatively less mobile resources through the building of organisational structures and mechanisms for managing repositories of knowledge (particularly organisational specialisation and selectively hiring appropriately skilled staff). This paper explores the management of human capital across different levels of export activity in Australian manufacturing firms. Analyses were based on 90 Australian-headquartered manufacturing exporters that responded to a survey. Overall, the results support the notion that firms need to accumulate knowledge as they internationalise. These results are discussed in terms of their consequences for HRM practices.

Examining the living with possums policy in Victoria, Australia : community knowledge, support and compliance

Studying the human dimensions of wildlife management issues is now considered to be an essential component
of wildlife research. This study examined the Living with Possums policy in Victoria, Australia, in terms of the policy’s
success in educating the community and ensuring community compliance. Postal surveys and telephone interviews
were conducted across three samples from Greater Melbourne. These samples included people who had experiences
with possums on their property (n = 340), veterinary clinics (n = 45) and the general public (n = 103). Significant
levels of non-compliance were uncovered, highlighting the need for a renewed public education campaign to take place
along with a continued interest in this issue from government agencies and councils. The study also revealed
discrepancies between the policy and public preferences for possum management, suggesting that a shift in the
recommended management technique may be warranted.

Need for belonging, relationship satisfaction, loneliness, and life satisfaction

Loneliness and the need to belong are two subjective states that, on the basis of prior research and theory, would appear to be related both to one another and to wellbeing. This study explored these relationships with a sample of 436 volunteer participants drawn from the Australian Unity Wellbeing database. Participants completed a survey that included a measure of satisfaction with personal relationships embedded in the Personal Wellbeing Index, the UCLA Loneliness scale, a measure of life satisfaction, and the Need to Belong Scale. While loneliness was weakly related to need to belong, it was strongly associated with the discrepancy between need to belong and satisfaction with personal relationships, which we used to measure unmet need for belonging. People living alone reported a lower need to belong and less satisfaction with personal relationships than those living with others. However, the discrepancy scores, life satisfaction scores and loneliness scores did not differ between these groups. Loneliness mediated the relationship between unmet need for belonging and wellbeing (life satisfaction). These findings support Baumeister and Leary’s “belongingness hypothesis” and clarify the relationship between these variables.