Reducing the risk of abandonment of assistive technologies for people with autism

This paper reports on an investigation that found that conventional techniques for including users in technology design are likely to fail if the user has autism. The heterogeneity of autistic symptomatology across cognitive, social, behavioural and communication domains suggests a 'single user' environment, while rendering typical design interaction techniques meaningless, making the need for assistive technologies great, and the risk of abandonment high. This complex problem of urgency and constraint was addressed through a Delphi study with a panel of psychologists critiquing design activities for people with autism. The major finding is that while each of the activities may work if modified, all require that the designer is well acquainted with autism in general and has a close working relationship based on trust with the individual user. If these requirements are met, there is no reason that the abandonment rate cannot be reduced.

Strategic competence : to soar above

Purpose – The purpose of this paper is to discuss the case for change at Deakin University Library and the change process adopted, and to explore organisational competences and the structural and strategic outcomes achieved. The Library's change process was driven by university strategic priorities and financial exigencies.

Design/methodology/approach – Change management theory is drawn on to illustrate that the change process adopted is influenced by the state of the organisation and the state of urgency. Four steps are outlined that encapsulate the process developed by the Library. These four steps draw on a book by Kotter and Rathberger, Our Iceberg Is Melting. The concept of strategic organisational competences as proposed by Thomson and Cole is adopted.

Findings – The case study demonstrates the need to take a structural and strategic view of the organisation when developing new models of service and ways of operating. An organisation needs to develop the capacity to manage both continuous and discontinuous change. The change process has delivered improvements to the Library's strategic and functional capabilities, as well as sustainable cost savings. Client satisfaction surveys indicate the quality of service provision has not diminished.

Originality/value – The paper proposes a change process that may suit other organisations. It advocates a simple conceptualisation of the process that will aid communication with key stakeholders. Further, to achieve the desired strategic and structural outcomes, it is critical to assess the strategic competence of the organisation.

Thought processes associated with reluctance in gay men to be tested for HIV

This study explored the thought processes that are associated with reluctance in gay men to be tested for HIV antibodies. The sample comprised 97 men who had not been tested for at least four years; 69 had never been tested. They were asked to imagine that someone had suggested that they be tested very soon and to identify, from the list provided, any negative thoughts prompted by this suggestion. The most commonly reported thoughts were that testing was unnecessary because risks had not been taken, that it was unnecessary because there were no symptoms, and that there was no urgency to be tested. Data were explored by means of factor analysis and comparisons across subgroups differing in risk level. The results are interpreted as indicating the use of rationalizations to buttress a decision not to be tested, the powerful influence on HIV decision-making exerted by salient perceptible features, and the ‘status quo bias’. Techniques that could be used to encourage testing in gay men are discussed.

Ambulance call triage outcomes for patients reporting pain : a retrospective cross-sectional analysis of pain score versus traige level

Objective: To identify any association between the response priority code generated during calls to the ambulance communication centre and patient reports of pain severity.

Methods: A retrospective analysis of patient care records was undertaken for all patients transported by paramedics over a 7-day period. The primary research interest was the association between the response code allocated at the time of telephone triage and the initial pain severity score recorded using a numeric rating scale (NRS). Univariate and multivariate logistic regression methods were used to analyse the association between the response priority variable and explanatory variables.

Results: There were 1246 cases in which both an initial pain score using the NRS and a response code were recorded. Of these cases, 716/1246 (57.5%) were associated with a code 1 ("time-critical") response. After adjusting for gender, age, cause of pain and duration of pain, a multivariate logistic regression analysis found no significant change in the odds of a patient in pain receiving a time-critical response compared with patients who had no pain, regardless of their initial pain score (NRS 1–3, odds ratio (OR) 1.11, 95% CI 0.7 to 1.8; NRS 4–7, OR 1.12, 95% CI 0.7 to 1.8; NRS 8–10, OR 0.84, 95% CI 0.5 to 1.4).

Conclusion: The severity of pain experienced by the patient appeared to have no influence on the priority (urgency) of the dispatch response. Triage systems used to prioritise ambulance calls and decide the urgency of response or type of referral options should consider pain severity to facilitate timely and humane care.

'Energetic space' : literary experience and learning

This essay is part of an interdisciplinary research project into literary aesthetics and its relationship with pedagogy. The paper brings cognitive and evolutionary scientific perspectives to bear on literary and cultural theory to address the aesthetic effect (defined as the transporting and transformative power of the literary text) and its potential personal or civic benefits. The paper offers non-transcendentalist explanations for the aesthetic experience, viewing it less as a privileged category of feeling than as an experience available to all symbolic beings. The paper also proposes an original thesis about the virtual and transformative space of reading as one that ultimately epitomises intellectual freedom. The inquiry is lent urgency by the current cultural and political climate in which not only literature but also literary studies, despite its long association with education and its prominent place in the Culture Wars, is in institutional decline.

An ABC approach to assessing the risk of violence at triage

There is evidence to suggest that the incidence of violent behaviour in the emergency department by patients toward staff is on the rise. As part of the process of determining urgency, triage nurses must assess the risk of violence at point of entry. The risk of violence, that is, behaviour that either involves a threat of physical or psychological harm to one's self or to others, is considered a critical predictor of urgency in mental health triage. A rapid violence risk assessment strategy will be described which can be utilised in emergency department triage.

An exploration of clinical decision-making in mental health triage

Mental health (MH) triage is a specialist area of clinical nursing practice that involves complex decision making. The discussion in this article draws on the findings of a Ph.D. study that involved a statewide investigation of the scope of MH triage nursing practice in Victoria, Australia. Although the original Ph.D. study investigated a number of core practices in MH triage, the focus of the discussion in this article is specifically on the findings related to clinical decision making in MH triage, which have not previously been published. The study employed an exploratory descriptive research design that used mixed data collection methods including a survey questionnaire (n = 139) and semistructured interviews (n = 21). The study findings related to decision making revealed a lack of empirically tested evidence-based decision-making frameworks currently in use to support MH triage nursing practice. MH triage clinicians in Australia rely heavily on clinical experience to underpin decision making and have little of knowledge of theoretical models for practice, such as methodologies for rating urgency. A key recommendation arising from the study is the need to develop evidence-based decision-making frameworks such as clinical guidelines to inform and support MH triage clinical decision making.

Do mass media campaigns capture and describe the experience of stroke symptoms?

Introduction: In 2006, the National Stroke Foundation of Australia launched the FAST (Face, Arm, Speech)/ Signs of Stroke (SOS) (5 symptom categories) campaigns designed to improve public awareness of stroke symptoms and the sense of urgency to present to hospital. However, there is little published review of how well such campaigns capture and describe the experience of stroke. This study aims to examine the awareness, content and language of the FAST/SOS campaigns by those experiencing stroke symptoms.
Methods: Interviews were conducted with either the stroke patient or a witness (incapacitated patients) whilst an inpatient at Box Hill or Maroondah Hospitals between August 2006 through April 2008. They were asked to describe awareness of campaigns, symptoms experienced (recorded verbatim and coded into campaign symptom categories) and to evaluate the descriptions of “Signs of Stroke” against their own experience (exact, somewhat, or not at all).
Results: Of 239 eligible stroke cases, 167 (70%) were interviewed (100 patients and 67 witnesses). Few (n= 20, 12%) were aware of the FAST campaign and only 16% recalled all three symptoms. Most recalled that it was “something” to do with the face, however facial droop (n=6) was less commonly experienced compared to speech impairments (n=16) and arm drift (n=13). FAST symptoms detected 84% (patients 77% and witnesses 94%) and SOS symptoms 100% of stroke patients. Patients not describing a FAST symptom (n=27) described: arm or hand numbness; hand incoordination; leg impairments; vision disturbances; or collapse. Approximately, half of patients and witnesses thought the SOS descriptions of the most commonly detected symptoms (arm/leg/face weakness or paralysis or numbness and speech impairments) exactly described the experience. Common language used to describe symptoms were: incoordination of hands or limbs; sudden difficulty walking; drooped/dropped face or mouth; slurred or loss of speech; pins and needles or tingling.
Conclusion: Both campaigns identified symptoms most commonly detected in those experiencing and reacting to symptoms. Both campaigns could portray symptoms more realistically using common descriptors without impacting on the simplicity of the messages

New teachers, professional knowledge and educational reform in New Zealand

This thesis examines the professional knowledge of new secondary school teachers in New Zealand, their negotiation of multiple discourses encountered in policy and practice, and their processes of professional identity formation. It is also a study of policy reform. In New Zealand, as elsewhere, recent educational and social reforms have brought about major changes to the way education is managed and implemented. These reforms emphasise market ideologies promoting consumer choice and responsibility, while measuring and monitoring quality and effectiveness. At the same time, the reforms attempt to alleviate social inequality. Teachers' negotiation of an accountability culture and the dominant equity policies is a major focus of this study. The study draws upon group interviews held with nine new teachers during the first two years of their teaching careers. The group interviews were designed to elicit extended narratives from individual teachers, as well as promote more interactive dialogue and reflections within the groups. Because the interviews were conducted at different points in their early careers, the study also has a longitudinal element, allowing insight into how teachers' views are formed or changed during an intense period of professional learning. Analysis of the teachers' narratives is informed by poststructural and feminist understandings of identity and knowledge and by a methodological orientation to writing as a method of enquiry. The thesis develops three main types of discussion and sets of arguments. The first examines new teachers' negotiation of the 'macro' context of teacher knowledge formation that is, their negotiation of an educational policy environment that juxtaposes an equity agenda with accountability controls. In order to historically situate these dilemmas, the particular political, social and educational context of New Zealand is examined. It is argued that teachers negotiate competing political and conceptual debates about social justice, equity and difference, and that this negotiation is central to the formation of professional knowledge. The analysis illustrates ways in which teachers make sense of equity discourses in educational policy and practice, and the apparent contradictions that arise from placing tight accountability standards on schools and teachers to achieve associated equity goals. The second type of discussion focuses on teachers' negotiation of the 'micro' dimension of professional knowledge, looking closely at the processes and practices that form professional identity. Against stage or developmental models of teacher identity, it is argued that professional identity is formed in an ongoing, uneven and fluid manner and is socially and discursively situated/embedded. It is further argued that professional knowledge and identity are entwined and that this relationship is most usefully understood through analysis of the discursive practices that frame teachers' working lives and through which teachers work out who they are or should become and what and how they (should) think. This analysis contributes new perspectives to debates in teacher education about teacher preparation and the knowledge required of teachers in current 'new times'. The final cluster of arguments brings together these macro and micro aspects of professional knowledge and identity with a case study of how new teachers negotiated a recent educational reform of senior secondary school qualifications in New Zealand. This reform has had a significant impact on secondary schools and on the way teachers, and New Zealanders in general, think about education, achievement and success. It was found that this reform significantly challenged new teachers to question their beliefs about assessment and justice in education, and what counts as success. This case study draws attention to the tensions between equity, academic excellence and standards-based assessment, and contributes to understanding how teacher professional knowledge forms both in the context of a specific educational policy reform and in relation to educational reform in general. This study contributes new knowledge to the formation of teacher professional knowledge and identity in an educational climate of change in New Zealand. The findings offer new insights for teacher educators, policymakers and schools into how teachers build, shape and sustain professional knowledge; how they juggle contradictions between a desire for justice, policy imperatives and teacher education rhetoric; the self-constructed, but contingent nature of professional knowledge and identity; and the urgency to address identity formation as part of teacher education and to take account of the dynamic ways in which identities form. These matters need to be articulated in teacher education both pre-service and in-service in order to address teacher retention and satisfaction, and teachers' commitment to equity reform in education.

Clinical, ethical and legal considerations in the treatment of newborns with non-ketotic hyperglycinaemia

Non-ketotic hyperglycinaemia (NKH) is a devastating neurometabolic disorder leading, in its classical form, to early death or severe disability and poor quality of life in survivors. Affected neonates may need ventilatory support during a short period of respiratory depression. The transient dependence on ventilation dictates urgency in decision-making regarding withdrawal of therapy. The occurrence of patients with apparent transient forms of the disease, albeit rare, adds uncertainty to the prediction of clinical outcome and dictates that the current practice of withholding or withdrawing therapy in these neonates be reviewed. Both bioethics and law take the view that treatment decisions should be based on the best interests of the patient. The medical-ethics approach is based on the principles of non-maleficence, beneficence, autonomy and justice. The law relating to withholding or withdrawing life-sustaining treatment is complex and varies between jurisdictions. Physicians treating newborns with NKH need to provide families with accurate and complete information regarding the disease and the relative probability of possible outcomes of the neonatal presentation and to explore the extent to which family members are willing to take part in the decision making process. Cultural and religious attitudes, which may potentially clash with bioethical and juridical principles, need to be considered.

Corporate governance : some key challenges and opportunities for accounting researchers

The focus on corporate governance has grown exponentially over the last decade. As evidenced by the increasing number of codes of best practice developed by leading international bodies such as the OECD, the Commonwealth and CalPERS (refer Demirag et al. (2000) for a fuller list of publications), corporate governance reform has now become a key global issue. Not only do factors such as the increasing globalisation of financial markets, the growth in multinational corporations and regional economic developments motivate the need for good corporate governance, but the recent spate of large corporate collapses such as Enron and WorldCom in the United States and HIH Insurance in Australia clearly signal the urgency for significant improvements in corporate accountability and reporting.

Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting

Background. Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization. However, the research–practice gap remains a persistent issue for the nursing profession.

Aims and objectives. The aim of this study was to gain an understanding of perceived influences on nurses' utilization of research, and explore what differences or commonalities exist between the findings of this research and those of studies that have been conducted in various countries during the past 10 years.

Design. Nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. The instrument comprised a 29-item validated questionnaire, titled Barriers to Research Utilisation Scale (BARRIERS Scale), an eight-item scale of facilitators, provision for respondents to record additional barriers and/or facilitators and a series of demographic questions.

Method. The questionnaire was administered in 2001 to all nurses (n = 761) working at a major teaching hospital in Melbourne, Australia. A 45% response rate was achieved.

Results. Greatest barriers to research utilization reported included time constraints, lack of awareness of available research literature, insufficient authority to change practice, inadequate skills in critical appraisal and lack of support for implementation of research findings. Greatest facilitators to research utilization reported included availability of more time to review and implement research findings, availability of more relevant research and colleague support.

Conclusion. One of the most striking features of the findings of the present study is that perceptions of Australian nurses are remarkably consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade.

Relevance to clinical practice. If the use of research evidence in practice results in better outcomes for our patients, this behoves us, as a profession, to address issues surrounding support for implementation of research findings, authority to change practice, time constraints and ability to critically appraise research with conviction and a sense of urgency.

The effects of cultural barriers on market entry strategy

The increasing interests worldwide urge researchers to examine the strategies used specifically for tackling the Chinese market. This urgency is brought forward by the fact of a low success rate of international businesses operating in China in the past twenty years. This paper identifies the fundamental barrier — cultural difference and its impact on Australia-China business practices. It identifies the differences which impinge on basic decision making processes. It raises the issue of where cultural factors should be placed in organizations. It stresses that consideration of cultural differences plays an important role in the success of entering the Chinese market. Through a single case study of an Australian organisation's operation in China, it is demonstrated that cultural differences are to be considered at a strategic level rather than an operational level. In this method, appropriate implementations will be able to be carried out.

Factors influencing consistency of triage using the Australasian triage scale : implications for guideline development

Objective: To examine the influence of the nurse, the type of patient presentation and the level of hospital service on consistency of triage using the Australasian Triage Scale.

Methods: A secondary analysis of survey data was conducted. The main study was undertaken to measure the reliability of 237 scenarios for inclusion in a national training programme. Nurses were recruited from a quota sample of Australian ED according to peer group. Analysis was performed to determine concordance: the percentage of responses in the modal triage category. Analysis of variance (anova) and Pearson correlations were used to investigate associations between the explanatory variables and concordance.

Results: A total of 42/50 (84%) participants returned questionnaires, providing 9946 scenario responses for analysis. Significant differences in concordance were observed by variables describing the type of patient presentation and level of urgency. Mean scores for the comparison group (adult pain; 70.7%) were higher than the groups involving a mental health or pregnancy presentations (61.4%; P≤ 0.001; 65.0%; P= 0.02). Modal responses at the extreme ends of the scale were higher than in the middle categories (P≤ 0.001). There was a significant main effect on concordance by type of service according to peer group (P= 0.03). Of the nine variables that described nurse characteristics, age was the only factor to influence the outcome (P= 0.05).

Conclusion: We identified significant problems with the consistency of triage for mental health and pregnancy presentations. Further research is needed to improve the guidelines on the implementation of the Australasian Triage Scale for these populations.

Self-injury and eating pathology

It was found that Urgency and lack of Perseverance were significantly elevated in women with self-injury or eating pathology, and significantly higher again in women with both these syndromes. A longitudinal design found that self-injury tends to progress from milder, compulsive forms, to more severe, impulsive forms over time. The portfolio examines the frequent co-occurrence of substance use and psychiatric disorders (Dual Diagnosis). Four primary conceptualisations of how dual diagnoses develop and present are discussed. These models are then applied to inform four case studies.