Testing the effectiveness of a Practice Development intervention on changing the culture of evidence based practice in an acute care environment

In this age of evidence-based practice, nurses are increasingly expected to use research evidence in a systematic and judicious way when making decisions about patient care practices. Clinicians recognise the role of research when it provides valid, realistic answers in practical situations. Nonetheless, research is still perceived by some nurses as external to practice and implementing research findings into practice is often difficult. Since its conceptual platform in the 1960s, the emergence and growth of Nursing Development Units, and later, Practice Development Units has been described in the literature as strategic, organisational vehicles for changing the way nurses think about nursing by promoting and supporting a culture of inquiry and research-based practice. Thus, some scholars argue that practice development is situated in the gap between research and practice. Since the 1990s, the discourse has shifted from the structure and outcomes of developing practice to the process of developing practice, using a Practice Development methodology; underpinned by critical social science theory, as a vehicle for changing the culture and context of care. The nursing and practice development literature is dominated by descriptive reports of local practice development activity, typically focusing on reflection on processes or outcomes of processes, and describing perceived benefits. However, despite the volume of published literature, there is little published empirical research in the Australian or international context on the effectiveness of Practice Development as a methodology for changing the culture and context of care - leaving a gap in the literature. The aim of this study was to develop, implement and evaluate the effectiveness of a Practice Development model for clinical practice review and change on changing the culture and context of care for nurses working in an acute care setting. A longitudinal, pre-test/post-test, non-equivalent control group design was used to answer the following research questions: 1. Is there a relationship between nurses' perceptions of the culture and context of care and nurses' perceptions of research and evidence-based practice? 2. Is there a relationship between engagement in a facilitated process of Practice Development and change in nurses' perceptions of the culture and context of care? 3. Is there a relationship between engagement in a facilitated process of Practice Development and change in nurses' perceptions of research and evidence-based practice? Through a critical analysis of the literature and synthesis of the findings of past evaluations of Nursing and Practice Development structures and processes, this research has identified key attributes consistent throughout the chronological and theoretical development of Nursing and Practice Development that exemplify a culture and context of care that is conducive to creating a culture of inquiry and evidence-based practice. The study findings were then used in the development, validation and testing of an instrument to measure change in the culture and context of care. Furthermore, this research has also provided empirical evidence of the relationship of the key attributes to each other and to barriers to research and evidence-based practice. The research also provides empirical evidence regarding the effectiveness of a Practice Development methodology in changing the culture and context of care. This research is noteworthy in its contribution to advancing the discipline of nursing by providing evidence of the degree to which attributes of the culture and context of care, namely autonomy and control, workplace empowerment and constructive team dynamics, can be connected to engagement with research and evidence-based practice.

The development and evaluation of an innovative nursing practice model to improve undergraduate nursing students' competence in paediatric physical assessment

Introduction The purpose of this study was to develop, implement and evaluate the impact of an educational intervention, comprising an innovative model of clinical decisionmaking and educational delivery strategy for facilitating nursing students‘ learning and development of competence in paediatric physical assessment practices. Background of the study Nursing students have an undergraduate education that aims to produce graduates of a generalist nature who demonstrate entry level competence for providing nursing care in a variety of health settings. Consistent with population morbidity and health care roles, paediatric nursing concepts typically form a comparatively small part of undergraduate curricula and students‘ exposure to paediatric physical assessment concepts and principles are brief. However, the nursing shortage has changed traditional nursing employment patterns and new graduates form the majority of the recruitment pool for paediatric nursing speciality staff. Paediatric nursing is a popular career choice for graduates and anecdotal evidence suggests that nursing students who select a clinical placement in their final year intend to seek employment in paediatrics upon graduation. Although concepts of paediatric nursing are included within undergraduate curriculum, students‘ ability to develop the required habits of mind to practice in what is still regarded as a speciality area of practice is somewhat limited. One of the areas of practice where this particularly impacts is in paediatric nursing physical assessment. Physical assessment is a fundamental component of nursing practice and competence in this area of practice is central to nursing students‘ development of clinical capability for practice as a registered nurse. Timely recognition of physiologic deterioration of patients is a key outcome of nurses‘ competent use of physical assessment strategies, regardless of the practice context. In paediatric nursing contexts children‘s physical assessment practices must specifically accommodate the child‘s different physiological composition, function and pattern of clinical deterioration (Hockenberry & Barrera, 2007). Thus, to effectively manage physical assessment of patients within the paediatric practice setting nursing students need to integrate paediatric nursing theory into their practice. This requires significant information processing and it is in this process where students are frequently challenged. The provision of rules or models can guide practice and assist novice-level nurses to develop their capabilities (Benner, 1984; Benner, Hooper-Kyriakidis & Stannard, 1999). Nursing practice models are cognitive tools that represent simplified patterns of expert analysis employing concepts that suit the limited reasoning of the inexperienced, and can represent the =rules‘ referred to by Benner (1984). Without a practice model of physical assessment students are likely to be uncertain about how to proceed with data collection, the interpretation of paediatric clinical findings and the appraisal of findings. These circumstances can result in ad hoc and unreliable nursing physical assessment that forms a poor basis for nursing decisions. The educational intervention developed as part of this study sought to resolve this problem and support nursing students‘ development of competence in paediatric physical assessment. Methods This study utilised the Context Input Process Product (CIPP) Model by Stufflebeam (2004) as the theoretical framework that underpinned the research design and evaluation methodology. Each of the four elements in the CIPP model were utilised to guide discrete stages of this study. The Context element informed design of the clinical decision-making process, the Paediatric Nursing Physical Assessment model. The Input element was utilised in appraising relevant literature, identifying an appropriate instructional methodology to facilitate learning and educational intervention delivery to undergraduate nursing students, and development of program content (the CD-ROM kit). Study One employed the Process element and used expert panel approaches to review and refine instructional methods, identifying potential barriers to obtaining an effective evaluation outcome. The Product element guided design and implementation of Study Two, which was conducted in two phases. Phase One employed a quasiexperimental between-subjects methodology to evaluate the impact of the educational intervention on nursing students‘ clinical performance and selfappraisal of practices in paediatric physical assessment. Phase Two employed a thematic analysis and explored the experiences and perspectives of a sample subgroup of nursing students who used the PNPA CD-ROM kit as preparation for paediatric clinical placement. Results Results from the Process review in Study One indicated that the prototype CDROM kit containing the PNPA model met the predetermined benchmarks for face validity and the impact evaluation instrumentation had adequate content validity in comparison with predetermined benchmarks. In the first phase of Study Two the educational intervention did not result in statistically significant differences in measures of student performance or self-appraisal of practice. However, in Phase Two qualitative commentary from students, and from the expert panel who reviewed the prototype CD-ROM kit (Study One, Phase One), strongly endorsed the quality of the intervention and its potential for supporting learning. This raises questions regarding transfer of learning and it is likely that, within this study, several factors have influenced students‘ transfer of learning from the educational intervention to the clinical practice environment, where outcomes were measured. Conclusion In summary, the educational intervention employed in this study provides insights into the potential e-learning approaches offer for delivering authentic learning experiences to undergraduate nursing students. Findings in this study raise important questions regarding possible pedagogical influences on learning outcomes, issues within the transfer of theory to practice and factors that may have influenced findings within the context of this study. This study makes a unique contribution to nursing education, specifically with respect to progressing an understanding of the challenges faced in employing instructive methods to impact upon nursing students‘ development of competence. The important contribution transfer of learning processes make to students‘ transition into the professional practice context and to their development of competence within the context of speciality practice is also highlighted. This study contributes to a greater awareness of the complexity of translating theoretical learning at undergraduate level into clinical practice, particularly within speciality contexts.

Identifying the learning development of students who are refugees

Students who are refugees need understanding and support to settle successfully into mainstream Australian classrooms. Teachers not aware of students’ prior learning and the process of second language acquisition may have difficulty providing the most appropriate learning environments to meet these students’ needs. This study found that, with no coordination of information on students’ learning backgrounds nor of their learning needs and development, students were in danger of being identified as at-risk of having a learning disability, with little support to substantiate such claims.

Up the junction? Exploiting knowledge-based development through supply chain and SME cluster interactions

Maximisation of Knowledge-Based Development (KBD) benefits requires effective dissemination and utilisation mechanisms to accompany the initial knowledge creation process. This work highlights the potential for interactions between Supply Chains (SCs) and Small and Medium sized Enterprise Clusters (SMECs), (including via ‘junction’ firms which are members of both networks), to facilitate such effective dissemination and utilisation of knowledge. In both these network types there are firms that readily utilise their relationships and ties for ongoing business success through innovation. The following chapter highlights the potential for such beneficial interactions between SCs and SMECs in key elements of KBD, particularly knowledge management, innovation and technology transfer. Because there has been little focus on the interactions between SCs and SMECs, particularly when firms simultaneously belong to both, this chapter examines the conduits through which information and knowledge can be transferred and utilised. It shows that each network type has its own distinct advantages in the types of information searched for and transferred amongst network member firms. Comparing and contrasting these advantages shows opportunities for both networks to leverage the knowledge sharing strengths of each other, through these ‘junctions’ to address their own weaknesses, allowing implications to be drawn concerning new ways of utilising relationships for mutual network gains.

Community engagement for development and application of 3D visualisation models : a two edged

Background: SEQ Catchments Ltd and QUT are collaborating on groundwater investigations in the SE Qld region, which utilise community engagement and 3D Visualisation methodologies. The projects, which have been funded by the Australian Government’s NHT and Caring for our Country programmes, were initiated from local community concerns regarding groundwater sustainability and quality in areas where little was previously known. ----- Objectives: Engage local and regional stakeholders to tap all available sources of information;•Establish on-going (2 years +) community-based groundwater / surface water monitoring programmes;•Develop 3D Visualisation from all available data; and•Involve, train and inform the local community for improved on-ground land and water use management. ----- Results and findings: Respectful community engagement yielded information, access to numerous monitoring sites and education opportunities at low cost, which would otherwise be unavailable. A Framework for Community-Based Groundwater Monitoring has been documented (Todd, 2008).A 3D visualisation models have been developed for basaltic settings, which relate surface features familiar to the local community with the interpreted sub-surface hydrogeology. Groundwater surface movements have been animated and compared to local rainfall using the time-series monitoring data.An important 3D visualisation feature of particular interest to the community was the interaction between groundwater and surface water. This factor was crucial in raising awareness of potential impacts of land and water use on groundwater and surface water resources.

Practising inspired leadership : the use of applied theatre 'prophetical' in the Executive Leadership Development Program for Queensland Health

The Executive Leadership Development Program embarked upon by Queensland Health as a part of the major reform program is discussed. The second stage of the program has begun and the main aim is to ensure leadership development across the organization.

Approaches for calculation of holding costs in the context of greenfield residential development

There are increasing indications that the contribution of holding costs and its impact on housing affordability is very significant. Their importance and perceived high level impact can be gauged from considering the unprecedented level of attention policy makers have given them recently. This may be evidenced by the embedding of specific strategies to address burgeoning holding costs (and particularly those cost savings associated with streamlining regulatory assessment) within statutory instruments such as the Queensland Housing Affordability Strategy, and the South East Queensland Regional Plan. However, several key issues require further investigation. Firstly, the computation and methodology behind the calculation of holding costs varies widely. In fact, it is not only variable, but in some instances completely ignored. Secondly, some ambiguity exists in terms of the inclusion of various elements of holding costs and assessment of their relative contribution. Perhaps this may in part be explained by their nature: such costs are not always immediately apparent. They are not as visible as more tangible cost items associated with greenfield development such as regulatory fees, government taxes, acquisition costs, selling fees, commissions and others. Holding costs are also more difficult to evaluate since for the most part they must be ultimately assessed over time in an ever-changing environment based on their strong relationship with opportunity cost which is in turn dependant, inter alia, upon prevailing inflation and / or interest rates. This paper seeks to provide a more detailed investigation of those elements related to holding costs, and in so doing determine the size of their impact specifically on the end user. It extends research in this area clarifying the extent to which holding costs impact housing affordability. Geographical diversity indicated by the considerable variation between various planning instruments and the length of regulatory assessment periods suggests further research should adopt a case study approach in order to test the relevance of theoretical modelling conducted.

Development of a method to measure upper eyelid pressure on the cornea

Purpose: The cornea is known to be susceptible to forces exerted by eyelids. There have been previous attempts to quantify eyelid pressure but the reliability of the results is unclear. The purpose of this study was to develop a technique using piezoresistive pressure sensors to measure upper eyelid pressure on the cornea. Methods: The technique was based on the use of thin (0.18 mm) tactile piezoresistive pressure sensors, which generate a signal related to the applied pressure. A range of factors that influence the response of this pressure sensor were investigated along with the optimal method of placing the sensor in the eye. Results: Curvature of the pressure sensor was found to impart force, so the sensor needed to remain flat during measurements. A large rigid contact lens was designed to have a flat region to which the sensor was attached. To stabilise the contact lens during measurement, an apparatus was designed to hold and position the sensor and contact lens combination on the eye. A calibration system was designed to apply even pressure to the sensor when attached to the contact lens, so the raw digital output could be converted to actual pressure units. Conclusions: Several novel procedures were developed to use tactile sensors to measure eyelid pressure. The quantification of eyelid pressure has a number of applications including eyelid reconstructive surgery and the design of soft and rigid contact lenses.

Introduction to the development of the ISPCAN child abuse screening tools

The World Report on Children and Violence, (Pinheiro, 2006) was produced at the request of the UN Secretary General and the UN General Assembly. This report recommended improvement in research on child abuse. ISPCAN representatives took this charge and developed 3 new instruments. We describe this background and introduce three new measures designed to assess the incidence and prevalence of child abuse and neglect.

A problem-posing intervention in the development of problem-solving competence of underachieving, middle-year students

This study reported on the issues surrounding the acquisition of problem-solving competence of middle-year students who had been ascertained as above average in intelligence, but underachieving in problem-solving competence. In particular, it looked at the possible links between problem-posing skills development and improvements in problem-solving competence. A cohort of Year 7 students at a private, non-denominational, co-educational school was chosen as participants for the study, as they undertook a series of problem-posing sessions each week throughout a school term. The lessons were facilitated by the researcher in the students’ school setting. Two criteria were chosen to identify participants for this study. Firstly, each participant scored above the 60th percentile in the standardized Middle Years Ability Test (MYAT) (Australian Council for Educational Research, 2005) and secondly, the participants all scored below the cohort average for Criterion B (Problem-solving Criterion) in their school mathematics tests during the first semester of Year 7. Two mutually exclusive groups of participants were investigated with one constituting the Comparison Group and the other constituting the Intervention Group. The Comparison Group was chosen from a Year 7 cohort for whom no problem-posing intervention had occurred, while the Intervention Group was chosen from the Year 7 cohort of the following year. This second group received the problem-posing intervention in the form of a teaching experiment. That is, the Comparison Group were only pre-tested and post-tested, while the Intervention Group was involved in the teaching experiment and received the pre-testing and post-testing at the same time of the year, but in the following year, when the Comparison Group have moved on to the secondary part of the school. The groups were chosen from consecutive Year 7 cohorts to avoid cross-contamination of the data. A constructionist framework was adopted for this study that allowed the researcher to gain an “authentic understanding” of the changes that occurred in the development of problem-solving competence of the participants in the context of a classroom setting (Richardson, 1999). Qualitative and quantitative data were collected through a combination of methods including researcher observation and journal writing, video taping, student workbooks, informal student interviews, student surveys, and pre-testing and post-testing. This combination of methods was required to increase the validity of the study’s findings through triangulation of the data. The study findings showed that participation in problem-posing activities can facilitate the re-engagement of disengaged, middle-year mathematics students. In addition, participation in these activities can result in improved problem-solving competence and associated developmental learning changes. Some of the changes that were evident as a result of this study included improvements in self-regulation, increased integration of prior knowledge with new knowledge and increased and contextualised socialisation.

Executive and organisational leadership development in universities : exploring key elements and perceptions

Organisational and leadership development is said to be one of the most challenging and important activities facing universities, particularly in the current environment of fast-paced change and accelerated age-related attrition. Succession leadership development being timely, the purpose of this study was to explore the nature of leadership development most suited to meeting the leadership and organisational development challenges for contemporary universities. A blend of literature-based and empirical research was undertaken. This resulted in seven papers submitted to internationally refereed journals; five papers published, one in press, and one under review. Six of these are sole authored papers and one is a co-authored paper. The papers identify some of the issues and challenges facing the tertiary sector. They shed light on factors influencing executive and organisational leadership development deriving from the literature review and from empirical research reporting the views of current university leaders. The papers and submission document herein include recommendations and suggested models informing executive and organisational leadership development in universities. The "Lantern" model - an Illuminated Model for Organisational Leadership Development - is a key original conceptual model framing the study.

Expert performance in sport and the dynamics of talent development

Research on expertise, talent identification and development has tended to be mono-disciplinary, typically adopting adopting neurogenetic deterministic or environmentalist positions, with an over-riding focus on operational issues. In this paper the validity of dualist positions on sport expertise is evaluated. It is argued that, to advance understanding of expertise and talent development, a shift towards a multi-disciplinary and integrative science focus is necessary, along with the development of a comprehensive multi-disciplinary theoretical rationale. Here we elucidate dynamical systems theory as a multi-disciplinary theoretical rationale for capturing how multiple interacting constraints can shape the development of expert performers. This approach suggests that talent development programmes should eschew the notion of common optimal performance models, emphasise the individual nature of pathways to expertise, and identify the range of interacting constraints that impinge on performance potential of individual athletes, rather than evaluating current performance on physical tests referenced to group norms.

Adiabatic compression testing - part I : historical development and evaluation of fluid dynamic processes including shock-wave considerations

Adiabatic compression testing of components in gaseous oxygen is a test method that is utilized worldwide and is commonly required to qualify a component for ignition tolerance under its intended service. This testing is required by many industry standards organizations and government agencies. This paper traces the background of adiabatic compression testing in the oxygen community and discusses the thermodynamic and fluid dynamic processes that occur during rapid pressure surges. This paper is the first of several papers by the authors on the subject of adiabatic compression testing and is presented as a non-comprehensive background and introduction.