The development of a program to assist international nursing students to be prepared for clinical practice in the Australian health care context

Health education in Western Countries has grown considerably in the last decade and this has occurred for a number of reasons. Specifically Universities actively recruit International students as the health workforce becomes global; also it is much easier for students to move and study globally. Internationally there is a health workforce shortage and if students gain a degree in a reputable university their ability to work globally is improved significantly. However, when studying to practice in the health care field the student must undertake clinical practice in an acute or aged care setting. This can be a significant problem for students who are culturally and linguistically diverse in an English speaking country such as Australia. The issues that can arise stem from the language differences where communication, interpretation understanding and reading the cultural norms of the health care setting are major challenges for International students. To assist international students to be successful in their clinical education, an extra curriculum workshop program was developed to provide additional support. The program which runs twice each year includes on-campus interactive workshops that are complemented by targeted support provided for students and clinical staff who are supervising students’ practice experience in the workplace. As this is an English speaking country the workshop is based on practicing reading, writing, listening and speaking, as well as exploring basic health care concepts and cultural differences. This enables students to gain knowledge of and practice interpretation of cultural norms and expectations in a safe environment. This innovative series of interactive workshops in a highly student-centred learning environment combine education with role play and discussion with peers who are supported by culturally aware and competent Educators. Over the years it has been running, the program has been undertaken by an increasing number of students. In 2011, more than 100 students are expected to participate. Student evaluation of the program has confirmed that it has assisted the majority of them to be successful in their clinical studies. Effectiveness of the project is measured throughout the program and in follow up sessions. This ongoing information allows for continuous development of the program that serves to meet individual needs of the International student, the University and Service providers such as the hospitals. This feedback from students regarding their increased comprehension of the Australian colloquial Language, healthcare terminology, critical thinking and clinical skill development and a cultural awareness also enables them to maintain their feelings of self confidence and self esteem.

Integration of CENA practice standards for postgraduate emergency nursing assessment

The use of professional competency standards to assess postgraduate nursing student’s clinical performance has been in place since 2004, at the Queensland University of Technology, School of Nursing & Midwifery (SONAM) when the Graduate Certificate in Emergency Nursing degree commenced. Emergency nursing students were assessed in their workplace, using a Clinical Performance Appraisal Tool or CPAT which was based on the Australian College of Critical Care Nurses (ACCCN) Competency Standards. With the subsequent formation of a separate Emergency Nursing Course advisory group in 2007, there was a review of clinical assessment course component. The release of the 2008 CENA revised Practice Standards for the Emergency Nursing Specialist’s, led to the emergency nursing course advisory committee supporting the integration of the CENA practice standards for assessment of emergency nurses in preference to the less relevant ACCCN competency standards. The SONAM emergency nursing study area team commenced the phasing in and progression of the CENA practice standards across the two Graduate Certificate units, and Graduate Diploma and Master of Nursing (emergency) clinical major options in 2009. As some units undertaken in the degree are available to nurses in other disciplines a separate CPAT was devised for the clinical assessments according to speciality context. The team has had to carefully consider how the professional standards are integrated into the teaching and assessment of the unit and not just applied instead of the ACCCN competency standards. Professional standards for the emergency context has also helped tailor course content and learning outcomes to be relevant across a number of emergency nursing contexts in Australia. The assessment of the CPAT is undertaken at the workplace by QUT appointed clinical lecturers. Clinical lecturers need to apply and have suitable postgraduate qualification to undertake the position. The clinical lecturer support role is well established at QUT. The integration of the new CENA practice standards has necessitated a review of the postgraduate assessment of emergency nurses. A clinical lecturer workshop has been organised to review role, scope and how to utilise the new look CENA based CPAT, clinical assessment format.

Psycho-markers of weight loss. The roles of TFEQ Disinhibition and Restraint in exercise-induced weight management

Eating behaviour traits, namely Disinhibition and Restraint, have the potential to exert an effect on food intake and energy balance. The effectiveness of exercise as a method of weight management could be influenced by these traits. Fifty eight overweight and obese participants completed 12-weeks of supervised exercise. Each participant was prescribed supervised exercise based on an expenditure of 500 kcal/session, 5 d/week for 12-weeks. Following 12-weeks of exercise there was a significant reduction in mean body weight (-3.26 ± 3.63 kg), fat mass (FM: -3.26 ± 2.64 kg), BMI (-1.16 ± 1.17 kg/m2)and waist circumference (WC: -5.0 ± 3.23 cm). Regression analyses revealed a higher baseline Disinhibition score was associated with a greater reduction in BMI and WC, while Internal Disinhibition was associated with a larger decrease in weight, %FM and WC. Neither baseline Restraint or Hunger were associated with any of the anthropometric markers at baseline or after 12-weeks. Furthermore, after 12-weeks of exercise, a decrease in Disinhibition and increase in Restraint were associated with a greater reduction in WC, whereas only Restraint was associated with a decrease in weight. Post-hoc analysis of the sub-factors revealed a decrease in External Disinhibition and increase in Flexible Restraint were associated with weight loss. However, an increase in Rigid Restraint was associated with a reduction in %FM and WC. These findings suggest that exercise-induced weight loss is more marked in individuals with a high level of Disinhibition. These data demonstrate the important roles that Disinhibition and Restraint play in the relationship between exercise and energy balance.

Improving self organizing capabilities of local communities for sustainable development in decentralized Indonesia : the roles of procedural justice and social learning

The development planning process introduced under Law No. 25/2004 is said to be a better approach to increase public participation in decentralised Indonesia. This Law has introduced planning mechanisms, called Musyawarah Perencanaan Pembangunan (musrenbang), to provide a forum for development planning. In spite of the expressed intention of these mechanisms to improve public participation, some empirical observations have cast doubt on the outcomes. As a result, some local governments have tried to provide alternative mechanisms for participatory local development planning processes. Since planning constitutes one of the most effective ways to improve community empowerment, this paper aims to examine the extent to which the alternative local development planning process in Indonesia provides sufficient opportunities to improve the self organising capabilities of communities to sustain development programs to meet local needs. In so doing, this paper explores the key elements and approaches of the concept of community empowerment and shows how they can be incorporated within planning processes. Based on this, it then examines the problems encountered by musrenbang in increasing community empowerment. Having done this, it is argued that to change current unfavourable outcomes, procedural justice and social learning approaches need to be incorporated as pathways to community empowerment. Lastly the capacity of an alternative local planning process, called Sistem Dukungan (SISDUK), introduced in South Sulawesi, offering scope to incorporate procedural justice and social learning is explored as a means to improve the self organizing capabilities of local communities.

'My grandchild has a disability' : impact on grandparenting identity, roles and relationships

Being a grandparent is an important and valued role for many older adults, who often have strong views about the type of grandparent they will be and what they will teach their grandchild. When their grandchild has a disability, grandparents may have to significantly adjust their expectations and interactions. This research explores if and how having a grandchild with a disability influences grandparents’ sense of identity and enactment of the grandparent role. Using qualitative purposive sampling, semi-structured interviews were conducted with 22 grandparents of children with an intellectual and/or physical disability residing in Brisbane, Australia. A thematic analysis identified three key themes characterising grandparent’s views: formation of grandparenting identity, styles of grandparenting, and role enactment. The results highlight the critical role of grandparents when a child has a disability, illustrating that the grandparenting experience and role enactment may be universal with only the context and delivery varying.

Perceptions of data quality dimensions and data roles

Several authors stress the importance of data’s crucial foundation for operational, tactical and strategic decisions (e.g., Redman 1998, Tee et al. 2007). Data provides the basis for decision making as data collection and processing is typically associated with reducing uncertainty in order to make more effective decisions (Daft and Lengel 1986). While the first series of investments of Information Systems/Information Technology (IS/IT) into organizations improved data collection, restricted computational capacity and limited processing power created challenges (Simon 1960). Fifty years on, capacity and processing problems are increasingly less relevant; in fact, the opposite exists. Determining data relevance and usefulness is complicated by increased data capture and storage capacity, as well as continual improvements in information processing capability. As the IT landscape changes, businesses are inundated with ever-increasing volumes of data from both internal and external sources available on both an ad-hoc and real-time basis. More data, however, does not necessarily translate into more effective and efficient organizations, nor does it increase the likelihood of better or timelier decisions. This raises questions about what data managers require to assist their decision making processes.

When the shoe doesn't quite fit: Regulating large commercial airports with expanding roles

Airports, whether publicly or privately owned or operated fill both public and private roles. They need to act as public infrastructure providers and as businesses which cover their operating costs. That leads to special governance concerns with respect to consumers and competitors which are only beginning to be addressed. These challenges are highlighted both by shifts in ownership status and by the expansion of roles performed by airports as passenger and cargo volumes continue to increase and as nearby urban areas expand outward towards airports. We survey five ways in which the regulatory shoe doesn‟t quite fit the needs. Our findings suggest that, while ad hoc measures limit political tension, new governance measures are needed.

Preparing general technology teachers in China for new roles and responsibilities

This paper discusses the conceptualization, implementation and initial findings of a professional learning program (PLP) which used LEGO® robotics as one of the tools for teaching general technology (GT)in China’s secondary schools. The program encouraged teachers to design learning environments that can be realistic, authentic, engaging and fun. 100 general technology teachers from high schools in 30 provinces of China participated. The program aimed to transform teacher classroom practice, change their beliefs and attitudes, allow teachers to reflect deeply on what they do and in turn to provide their students with meaningful learning. Preliminary findings indicate that these teachers had a huge capacity for change. They were open-minded and absorbed new ways of learning and teaching. They became designers who developed innovative models of learning which incorporated learning processes that effectively used LEGO® robotics as one of the more creative tools for teaching GT.

Teaching undergraduate students community nursing : using action research to increase engagement and learning

Nurses play a pivotal role in responding to the changing needs of community health care. Therefore, nursing education must be relevant, responsive, and evidence based. We report a case study of curriculum development in a community nursing unit embedded within an undergraduate nursing degree. We used action research to develop, deliver, evaluate, and redesign the curriculum. Feedback was obtained through self-reflection, expert opinion from community stakeholders, formal student evaluation, and critical review. Changes made, especially in curriculum delivery, led to improved learner focus and more clearly linked theory and practice. The redesigned unit improved performance, measured with the university's student evaluation of feedback instrument (increased from 0.3 to 0.5 points below to 0.1 to 0.5 points above faculty mean in all domains), and was well received by teaching staff. The process confirmed that improved pedagogy can increase student engagement with content and perception of a unit as relevant to future practice.

Putting paid to prescribed roles : a new era for Australian women and philanthropy

In redefining our understanding of women’s roles in contemporary Australian philanthropy, the impact of major contextual and demographic changes, as well as changes in women’s roles, responsibilities and opportunities need to be considered. Although academic study of philanthropy and the wider third sector is increasing in Australia, literature searches have revealed little current data on the giving patterns and philanthropic drivers for contemporary Australian women, particularly emerging cohorts (one ABS survey looks at giving patterns – ABS, 2000b: 32). In contrast, there is increasing interest in the US, where it is acknowledged that more women are becoming independent holders of wealth; and that interested donors have specific needs, desires and motivations in terms of knowledge, power, marketing and response to their philanthropy (see for example, Grace 2000; McCarthy 2001; Women’s Philanthropy Institute 2002). These varied demographic, social and economic drivers, which could also be expected to encourage new cohorts of Australian women to give, will be examined within our definition of women in philanthropy, and a brief history of women’s philanthropy in Australia, in order to inform future in-depth analyses of Australian women donors.

A case study examination of the influence of cultural diversity in the multicultural nursing workforce on the quality of care and patient safety in a Saudi Arabian hospital

The purpose of the study: The purpose of this study is to investigate the influence of cultural diversity, in a multicultural nursing workforce, on the quality and safety of patient care and the work environment at King Abdul-Aziz Medical City, Riyadh region. Study background: Due to global migration and workforce mobility, to varying degrees, cultural diversity exists in most health services around the world, particularly occurring where the health care workforce is multicultural or where the domestic population comprises minority groups from different cultures speaking different languages. Further complexities occur when countries have a multicultural workforce which is different from the population for whom they care, in addition to the workers being from culturally diverse countries and with different languages. In Saudi Arabia the health system is mainly staffed by expatriate nurses who comprise 67.7% of the total number of nurses. Study design: This research utilised a case study design which incorporated multiple methods including survey, qualitative interviews and document review. Methods: The participant nurses were selected for the survey via a population sampling strategy; 319 nurses returned their completed Safety Climate Survey questionnaires. Descriptive and inferential statistics (Kruskal–Wallis test) were used to analyse survey data. For the qualitative component of the study, a purposive sampling strategy was used; 24 nurses were interviewed using a semi-structured interview technique. The documentary review included KAMC-R policy documents that met the inclusion criteria using a predetermined data abstraction instrument. Content analysis was used to analyse the policy documents data. Results: The data revealed the nurses‘ perceptions of the clinical climate in this multicultural environment is that it was unsafe, with a mean score of 3.9 out of 5. No significant difference was detected between the age groups or years of experience of the nurses and the perception of safety climate in this context; the study did reveal a statistically significant difference between the cultural background categories and the perception of safety climate. The qualitative phase indicated that the nurses within this environment were struggling to achieve cultural competence; consequently, they were having difficulties in meeting the patients‘ cultural and spiritual needs as well as maintaining a high standard of care. The results also indicated that nurses were disempowered in this context. Importantly, there was inadequate support by the organisation to manage the cultural diversity issue and to protect patients from any associated risks, as demonstrated by the policy documents and supported by the nurses‘ experiences. The study also illustrated the limitations of the conceptual framework of cultural competence when tested in this multicultural workforce context. Therefore, this study generated amendments to the model that is suitable to be used in the context of a multicultural nursing workforce. Conclusion: The multicultural nature of this nursing work environment is inherently risky due to the conflicts that arise from the different cultural norms, beliefs, behaviours and languages. Further, there was uncertainty within the multicultural nursing workforce about the clinical and cultural safety of the patient care environment and about the cultural safety of the nursing workforce. The findings of the study contribute important new knowledge to the area of patient and nurse safety in a multicultural environment and contribute theoretical development to the field of cultural competence. Specifically, the findings will inform policy and practice related to patient care in the context of cultural diversity.

The performance and politics of practice for New Graduate Nurses

The change from nursing student to Registered Nurse (RNs) is both a desirable and anticipated event for New Graduate Nurses (NGNs). Having completed their formal education, most NGNs approach the threshold of their professional career with mixed emotions. While excited about the future and eagerly awaiting the commencement of employment, many are aware that this change also signifies a time of personal upheaval, professional insecurity and further personal learning. In the nursing professions’ enthusiasm to facilitate a smooth passage for NGNs a vast literature now addresses preparation-for-practice degrees, as well as the perceived workplace deficits and support needs of NGNs. However, the importance this change from working as a student to working as a NGN is not well conceptualised, theorised or understood as this largely instrumental literature essentially reduces the problematisation of the NGN transition experience to the problematisation of the individual by identifying NGNs as ‘the’ problem. Subsequently it fails to expose or challenge the normative assumptions underpinning processes that have formerly been considered solutions, or, the impact of such processes in a workplace that frames itself as “supportive”. Conspicuously absent is an exploration of how the NGN role is performed by former students, now beginning RNs undergoing the very personal transition of “becoming registered nurses”. Using Goffman’s (1956) theorisation of performance in everyday life exploring how process and meaning in mundane interactions present themselves in the “regular” lives of people at large, and Margaret Archer’s (2000) work emphasising the significance of the inner dialogue for managing the emotions that emerge out of situations that confront us, this paper draws upon data collected during a study of NGNs’ experience of transition to practice (Malouf 2010). It focuses on an emergent understanding of the need to differentiate the performance of ‘student’ from that of ‘NGN’ role. Further, it explores how these roles have become conflated into a conceptual continuum and viewed as a slide from student to NGN performance, rather than a significant moment of change involving roles that need to be distinctly defined as a necessary precursor to enhancing and supporting the professional and personal development of beginning practitioners.

Engaging undergraduate nursing students in face-to-face tutorials

Chronic nursing shortages have placed increasing pressure on many nursing schools to recruit greater numbers of students with the consequence of larger class sizes. Larger class sizes have the potential to lead to student disengagement. This paper describes a case study that examined the strategies used by a group of nursing lecturers to engage students and to overcome passivity in a Bachelor of Nursing programme. A non-participant observer attended 20 tutorials to observe five academics deliver four tutorials each. Academics were interviewed both individually and as a group following the completion of all tutorial observations. All observations, field notes, interviews and focus groups were coded separately and major themes identified. From this analysis two broad categories emerged: getting students involved; and engagement as a struggle. Academics used a wide variety of techniques to interest and involve students. Additionally, academics desired an equal relationship with students. They believed that both they and the students had some power to influence the dynamics of tutorials and that neither party had ultimate power. The findings of this study serve to re-emphasise past literature which suggests that to engage students, the academics must also engage.