A Delphi study to validate an advanced practice nursing tool

Aim This paper is a report of a study conducted to validate an instrument for measuring advanced practice nursing role delineation in an international contemporary health service context using the Delphi technique. Background Although most countries now have clear definitions and competency standards for nurse practitioners, no such clarity exists for many advanced practice nurse roles, leaving healthcare providers uncertain whether their service needs can or should be met by an advanced practice nurse or a nurse practitioner. The validation of a tool depicting advanced practice nursing is essential for the appropriate deployment of advanced practice nurses. This paper is the second in a three-phase study to develop an operational framework for assigning advanced practice nursing roles. Method An expert panel was established to review the activities in the Strong Model of Advanced Practice Role Delineation tool. Using the Delphi technique, data were collected via an on-line survey through a series of iterative rounds in 2008. Feedback and statistical summaries of responses were distributed to the panel until the 75% consensus cut-off was obtained. Results After three rounds and modification of five activities, consensus was obtained for validation of the content of this tool. Conclusion The Strong Model of Advanced Practice Role Delineation tool is valid for depicting the dimensions of practice of the advanced practice role in an international contemporary health service context thereby having the potential to optimize the utilization of the advanced practice nursing workforce.

Evaluating the effect of a patient education brochure on patients’ expectations and satisfaction with emergency department service

Introduction: The purpose of this study was to assess the capacity of a written intervention, in this case a patient information brochure, to improve patient satisfaction during an Emergency Department (ED) visit. For the purpose of measuring the effect of the intervention the ED journey was conceptualised as a series of distinct areas of service comprising waiting time, service by the triage nurse, care from doctors and nurses and information giving Background of study: Research into patient satisfaction has become a widespread activity endorsed by both governments and hospital administrations. The literature on ED patient satisfaction has consistently indicated three primary areas of patient dissatisfaction: waiting time, nursing care and communication. Recent developments in the literature on patient satisfaction studies however have highlighted the relationship between patients. expectations of a service encounter and their consequent assessment of the experience as dissatisfying or satisfying. Disconfirmation theory posits that the degree to which expectations are confirmed will affect subsequent levels of satisfaction. The conceptual framework utilised in this study is Coye.s (2004) model of disconfirmation. Coye while reiterating satisfaction is a consequence of the degree expectations are either confirmed or disconfirmed also posits that expectations can be modified by interventions. Coye.s work conceptualises these interventions as intra encounter experiences (cues) which function to adjust expectations. Coye suggests some cues are unintended and may have a negative impact which also reinforces the value of planned cues intended to meet or exceed consumer expectations. Consequently the brochure can be characterized as a potentially positive cue, encouraging the patient to understand processes and to orient them in what can be a confronting environment. Only a limited number of studies have examined the effect of written interventions within an ED. No studies could be located which have tested the effect of ED interventions using a conceptual framework which relates the effect of the degree to which expectations are confirmed or disconfirmed in terms of satisfaction with services. Method: Two studies were conducted. Study One used qualitative methods to explore patients. expectations of the ED from the perspective of both patients and health care professionals. Study One was used in part to direct the development of the intervention (brochure) in Study Two. The brochure was an intervention designed to modify patients. expectations thus increasing their satisfaction with the provision of ED service. As there was no existing tools to measure ED patients. expectations and satisfaction a new tool was also developed based on the findings and the literature of Study One. Study Two used a non-randomised, quasi-experimental approach using a non-equivalent post-test only comparison group design used to investigate the effect of the patient education brochure (Stommel and Wills, 2004). The brochure was disseminated to one of two study groups (the intervention group). The effect of the brochure was assessed by comparing the data obtained from both the intervention and control group. These two groups consisted of 150 participants each. It was expected that any differences in the relevant domains selected for examination would indicate the effect of the brochure both on expectation and potentially satisfaction. Results: Study One revealed several areas of common ground between patients and nurses in terms of relevant content for the written intervention, including the need for information on the triage system and waiting times. Areas of difference were also found with patients emphasizing communication issues, whereas focus group members expressed concern that patients were often unable to assimilate verbal information. The findings suggested the potential utility of written material to reinforce verbal communication particularly in terms of the triage process and other ED protocols. This material was synthesized within the final version of the written intervention. Overall the results of Study Two indicated no significant differences between the two groups. The intervention group did indicate a significant number of participants who viewed the brochure of having changed their expectations. The effect of the brochure may have been obscured by a lack of parity between the two groups as the control group presented with statistically significantly higher levels of acuity and experienced significantly shorter waiting times. In terms of disconfirmation theory this would suggest expectations that had been met or exceeded. The results confirmed the correlation of expectations with satisfaction. Several domains also indicated age as a significant predictor with older patients tending to score higher satisfaction results. Other significant predictors of satisfaction established were waiting time and care from nurses, reinforcing the combination of efficient service and positive interpersonal experiences as being valued by patients. Conclusions: Information presented in written form appears to benefit a significant number of ED users in terms of orientation and explaining systems and procedures. The degree to which these effects may interact with other dimensions of satisfaction however is likely to be limited. Waiting time and interpersonal behaviours from staff also provide influential cues in determining satisfaction. Written material is likely to be one element in a series of coordinated strategies to improve patient satisfaction during periods of peak demand.

Implementation and evaluation of a new model of nursing practice in radiation oncology

Patients undergoing radiation therapy for cancer face a series of challenges that require support from a multidisciplinary team which includes radiation oncology nurses. However, the specific contribution of nursing, and the models of care that best support the delivery of nursing interventions in the radiotherapy setting, is not well described. In this case study, the Interaction Model of Client Health Behaviour and the associated principles of person-centred care were incorporated into a new model of care that was implemented in one radiation oncology setting in Brisbane, Australia. The new model of care was operationalised through a Primary Nursing/Collaborative Practice framework. To evaluate the impact of the new model for patients and health professionals, multiple sources of data were collected from patients and clinical staff prior to, during, and 18 months following introduction of the practice redesign. One cohort of patients and clinical staff completed surveys incorporating measures of key outcomes immediately prior to implementation of the model, while a second cohort of patients and clinical staff completed these same surveys 18 months following introduction of the model. In-depth interviews were also conducted with nursing, medical and allied health staff throughout the implementation phase to obtain a more comprehensive account of the processes and outcomes associated with implementing such a model. From the patients’ perspectives, this study demonstrated that, although adverse effects of radiotherapy continue to affect patient well-being, patients continue to be satisfied with nursing care in this specialty, and that they generally reported high levels of functioning despite undergoing a curative course of radiotherapy. From the health professionals’ perspective, there was evidence of attitudinal change by nursing staff within the radiotherapy department which reflected a greater understanding and appreciation of a more person-centred approach to care. Importantly, this case study has also confirmed that a range of factors need to be considered when redesigning nursing practice in the radiotherapy setting, as the challenges associated with changing traditional practices, ensuring multidisciplinary approaches to care, and resourcing a new model were experienced. The findings from this study suggest that the move from a relatively functional approach to a person-centred approach in the radiotherapy setting has contributed to some improvements in the provision of individualised and coordinated patient care. However, this study has also highlighted that primary nursing may be limited in its approach as a framework for patient care unless it is supported by a whole team approach, an appropriate supportive governance model, and sufficient resourcing. Introducing such a model thus requires effective education, preparation and ongoing support for the whole team. The challenges of providing care in the context of complex interdisciplinary relationships have been highlighted by this study. Aspects of this study may assist in planning further nursing interventions for patients undergoing radiotherapy for cancer, and continue to enhance the contribution of the radiation oncology nurse to improved patient outcomes.

Using digital rights management for securing data in a medical research environment

We propose a digital rights management approach for sharing electronic health records in a health research facility and argue advantages of the approach. We also give an outline of the system under development and our implementation of the security features and discuss challenges that we faced and future directions.

Mutual protection in a cloud computing environment

The term “cloud computing” has emerged as a major ICT trend and has been acknowledged by respected industry survey organizations as a key technology and market development theme for the industry and ICT users in 2010. However, one of the major challenges that faces the cloud computing concept and its global acceptance is how to secure and protect the data and processes that are the property of the user. The security of the cloud computing environment is a new research area requiring further development by both the academic and industrial research communities. Today, there are many diverse and uncoordinated efforts underway to address security issues in cloud computing and, especially, the identity management issues. This paper introduces an architecture for a new approach to necessary “mutual protection” in the cloud computing environment, based upon a concept of mutual trust and the specification of definable profiles in vector matrix form. The architecture aims to achieve better, more generic and flexible authentication, authorization and control, based on a concept of mutuality, within that cloud computing environment.

Effect of pedestrian movement on MIMO-OFDM channel capacity in an indoor environment

The rapid growth of mobile telephone use, satellite services, and now the wireless Internet and WLANs are generating tremendous changes in telecommunication and networking. As indoor wireless communications become more prevalent, modeling indoor radio wave propagation in populated environments is a topic of significant interest. Wireless MIMO communication exploits phenomena such as multipath propagation to increase data throughput and range, or reduce bit error rates, rather than attempting to eliminate effects of multipath propagation as traditional SISO communication systems seek to do. The MIMO approach can yield significant gains for both link and network capacities, with no additional transmitting power or bandwidth consumption when compared to conventional single-array diversity methods. When MIMO and OFDM systems are combined and deployed in a suitable rich scattering environment such as indoors, a significant capacity gain can be observed due to the assurance of multipath propagation. Channel variations can occur as a result of movement of personnel, industrial machinery, vehicles and other equipment moving within the indoor environment. The time-varying effects on the propagation channel in populated indoor environments depend on the different pedestrian traffic conditions and the particular type of environment considered. A systematic measurement campaign to study pedestrian movement effects in indoor MIMO-OFDM channels has not yet been fully undertaken. Measuring channel variations caused by the relative positioning of pedestrians is essential in the study of indoor MIMO-OFDM broadband wireless networks. Theoretically, due to high multipath scattering, an increase in MIMO-OFDM channel capacity is expected when pedestrians are present. However, measurements indicate that some reductions in channel capacity could be observed as the number of pedestrians approaches 10 due to a reduction in multipath conditions as more human bodies absorb the wireless signals. This dissertation presents a systematic characterization of the effects of pedestrians in indoor MIMO-OFDM channels. Measurement results, using the MIMO-OFDM channel sounder developed at the CSIRO ICT Centre, have been validated by a customized Geometric Optics-based ray tracing simulation. Based on measured and simulated MIMO-OFDM channel capacity and MIMO-OFDM capacity dynamic range, an improved deterministic model for MIMO-OFDM channels in indoor populated environments is presented. The model can be used for the design and analysis of future WLAN to be deployed in indoor environments. The results obtained show that, in both Fixed SNR and Fixed Tx for deterministic condition, the channel capacity dynamic range rose with the number of pedestrians as well as with the number of antenna combinations. In random scenarios with 10 pedestrians, an increment in channel capacity of up to 0.89 bits/sec/Hz in Fixed SNR and up to 1.52 bits/sec/Hz in Fixed Tx has been recorded compared to the one pedestrian scenario. In addition, from the results a maximum increase in average channel capacity of 49% has been measured while 4 antenna elements are used, compared with 2 antenna elements. The highest measured average capacity, 11.75 bits/sec/Hz, corresponds to the 4x4 array with 10 pedestrians moving randomly. Moreover, Additionally, the spread between the highest and lowest value of the the dynamic range is larger for Fixed Tx, predicted 5.5 bits/sec/Hz and measured 1.5 bits/sec/Hz, in comparison with Fixed SNR criteria, predicted 1.5 bits/sec/Hz and measured 0.7 bits/sec/Hz. This has been confirmed by both measurements and simulations ranging from 1 to 5, 7 and 10 pedestrians.

Developing a sustainability assessment model : the sustainable infrastructure, land-use, environment and transport model

Measuring the comparative sustainability levels of cities, regions, institutions and projects is an essential procedure in creating sustainable urban futures. This paper introduces a new urban sustainability assessment model: “The Sustainable Infrastructure, Land-use, Environment and Transport Model (SILENT)”. The SILENT Model is an advanced geographic information system and indicator-based comparative urban sustainability indexing model. The model aims to assist planners and policy makers in their daily tasks in sustainable urban planning and development by providing an integrated sustainability assessment framework. The paper gives an overview of the conceptual framework and components of the model and discusses the theoretical constructs, methodological procedures, and future development of this promising urban sustainability assessment model.

Bridging the gap between tertiary education and work : a model of situated learning in accountancy

In professions such as teaching, health sciences (medicine, nursing, allied health), and built environment (engineering), significant work-based learning through practica is an essential element before graduation. However, there is no such requirement in Accountancy. This thesis reports the findings of a qualitative case study of the development and implementation of a Workplace Learning Experience Program in Accountancy at the Queensland University of Technology (QUT) in Australia. The case study of this intervention, based on sociocultural learning theory, provides the grounds for the development of a new model of teaching and learning for accounting education. The survey and interview-based study documents the responses of two cohorts of university students and a group of employers to a work placement program. The study demonstrates that a 100 hour work placement in Accountancy has elements that enhance student learning. It demonstrates the potential value of the application of sociocultural theories of learning, especially the concept of situated learning involving legitimate peripheral participation (Lave & Wenger, 1991). This research establishes the theoretical base for a paradigm shift for the Accountancy profession to acknowledge work placements prior to graduation as a major element of learning. It is argued that the current model of accounting education requires reform to better align university and workplace learning.

A snapshot of Australian nurse practitioners’ extended practice activities

Introduction The Australian Nurse Practitioner Project (AUSPRAC) was initiated to examine the introduction of nurse practitioners into the Australian health service environment. The nurse practitioner concept was introduced to Australia over two decades ago and has been evolving since. Today, however, the scope of practice, role and educational preparation of nurse practitioners is well defined (Gardner et al, 2006). Amendments to specific pre-existing legislation at a State level have permitted nurse practitioners to perform additional activities including some once in the domain of the medical profession. In the Australian Capital Territory, for example 13 diverse Acts and Regulations required amendments and three new Acts were established (ACT Health, 2006). Nurse practitioners are now legally authorized to diagnose, treat, refer and prescribe medications in all Australian states and territories. These extended practices differentiate nurse practitioners from other advanced practice roles in nursing (Gardner, Chang & Duffield, 2007). There are, however, obstacles for nurse practitioners wishing to use these extended practices. Restrictive access to Medicare funding via the Medicare Benefit Scheme (MBS) and the Pharmaceutical Benefit Scheme (PBS) limit the scope of nurse practitioner service in the private health sector and community settings. A recent survey of Australian nurse practitioners (n=202) found that two-thirds of respondents (66%) stated that lack of legislative support limited their practice. Specifically, 78% stated that lack of a Medicare provider number was ‘extremely limiting’ to their practice and 71% stated that no access to the PBS was ‘extremely limiting’ to their practice (Gardner et al, in press). Changes to Commonwealth legislation is needed to enable nurse practitioners to prescribe medication so that patients have access to PBS subsidies where they exist; currently patients with scripts which originated from nurse practitioners must pay in full for these prescriptions filled outside public hospitals. This report presents findings from a sub-study of Phase Two of AUSPRAC. Phase Two was designed to enable investigation of the process and activities of nurse practitioner service. Process measurements of nurse practitioner services are valuable to healthcare organisations and service providers (Middleton, 2007). Processes of practice can be evaluated through clinical audit, however as Middleton cautions, no direct relationship between these processes and patient outcomes can be assumed.

A preferred music listening intervention to reduce anxiety in older adults with dementia in nursing homes

Aim: This article reports the results of a study evaluating a preferred music listening intervention for reducing anxiety in older adults with dementia in nursing homes. Background. Anxiety can have a significant negative impact on older adults’ functional status, quality of life and health care resources. However, anxiety is often under-diagnosed and inappropriately treated in those with dementia. Little is known about the use of a preferred music listening intervention for managing anxiety in those with dementia.---------- Design: A quasi-experimental pretest and posttest design was used. ---------- Methods: This study aimed to evaluate the effectiveness of a preferred music listening intervention on anxiety in older adults with dementia in nursing home. Twenty-nine participants in the experimental group received a 30-minute music listening intervention based on personal preferences delivered by trained nursing staff in mid-afternoon, twice a week for six weeks. Meanwhile, 23 participants in the control group only received usual standard care with no music. Anxiety was measured by Rating Anxiety in Dementia at baseline and week six. Analysis of covariance (ANCOVA) was used to determine the effectiveness of a preferred music listening intervention on anxiety at six weeks while controlling for pretest anxiety, age and marital status. Results. ANCOVA results indicated that older adults who received the preferred music listening had a significantly lower anxiety score at six weeks compared with those who received the usual standard care with no music (F = 12Æ15, p = 0Æ001).---------- Conclusions: Preferred music listening had a positive impact by reducing the level of anxiety in older adults with dementia. Relevance to clinical practice. Nursing staff can learn how to implement preferred music intervention to provide appropriate care tailored to the individual needs of older adults with dementia. Preferred music listening is an inexpensive and viable intervention to promote mental health of those with dementia.

Transitioning toward transdisciplinary learning in a multidisciplinary environment

Multidisciplinary learning, interdisciplinary learning and transdisciplinary learning are often used with a similar meaning, but the misunderstanding of these terms may cause a failure of defining learner needs and developing high quality learning design. In this article, the three terms are reviewed in line with learner engagement and are conceptualised according to different types and levels of interactivity. An undergraduate course, named Creative Industries: Making Connections, was designed to deliver various learning modules to over 1200 students from 11 different disciplines in a blended learning mode. A visual communication learning module in the course, in particular, challenges students as well as academic staff to experience transdisciplinary learning. A survey was conducted to evaluate students' learning experience in the visual communication learning module. The results of the survey bring up meaningful implications for the realisation of transdisciplinary learning.