Training frontline workers : drug education from theory to practice

This study investigated the effectiveness of alcohol and other drug education by examining practice change in workers when they returned to their workplace, identifying barriers to and supports for that practice change. The influencing characteristics of the individual, their team environment and their organisation have also been identified.

Clinical nurse research consultant : a clinical and academic role to advance practice and the discipline of nursing

Aims:  This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role. Background:  Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians. Data sources:  International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant. Discussion:  The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus. Implications for nursing:  Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support. Conclusion:  The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.

Factors to drive clinical practice improvement in a Malaysian intensive care unit : assessment of organisational readiness using a mixed method approach

This study assessed organisational readiness and factors to drive clinical practice improvement for VAP, CRBSI and PU in a Malaysian intensive care unit (ICU). A mixed method study approach was undertaken in a 16-bed ICU in regional Malaysia using an environmental scan, key informant interviews, staff surveys, and patient audit to elucidate factors contributing to planning for clinical practice improvement. Measurements of sustainability of practice and regard for the practice environment were assessed using validated measures. An environmental scan demonstrated high patient occupancy and case load. Nineteen percent of ICU patients developed complications according to validated measures. Survey results indicated that the majority of nurses had a good knowledge of strategies to prevent ICU complications and a positive attitude toward change processes. Engaging executive leadership was identified as crucial in priming the clinical site for practice change. Providing nurses with tools to monitor their clinical practice and empowering them to change practices are important in improving clinical outcomes.

Improving child protection services: Australian parents' and grandparents' perspectives on what needs to change

This exploratory, small-scale research aimed to understand parents’ and grandparents’ experiences and expectations of child protection investigations. Semi-structured, in-depth interviews were conducted with nine participants. The central theme, captured as ‘a domino effect’, crystallises the participants’ views of why it is important to improve child protection services; that there were significant practical relationship repercussions in families’ lives beyond the immediate investigation. The sub-themes that emerged – support within systemic complexity, policies in practice, intervention processes and practices, and ‘it’s just a job to them’ –suggested how child protection services contributed to ‘the domino effect’ in their lives. A final sub-theme indicated participants’ awareness of the complexity and difficulty of child protection as a job, notwithstanding their expressed frustrations. We have made practical recommendations based on participants’ perspectives about ‘what needs to change?’, and suggestions for improvements to practise that centralise social work as a profession which values the professional relationship with services users. We also suggest that the professional relationship should extend beyond the interpersonal to guiding services users within the legal complexities in contemporary child protection. Being exploratory, this study and its recommendations guide future research to contribute improving child protection services.

A qualitative analysis of leadership styles and the selection of quality improvement in primary care practice

In the Practice Change Model, physicians act as key stakeholders, people who have both an investment in the practice and the capacity to influence how the practice performs. This leadership role is critical to the development and change of the practice. Leadership roles and effectiveness are an important factor in quality improvement in primary care practices.^ The study conducted involved a comparative case study analysis to identify leadership roles and the relationship between leadership roles and the number and type of quality improvement strategies adopted during a Practice Change Model-based intervention study. The research utilized secondary data from four primary care practices with various leadership styles. The practices are located in the San Antonio region and serve a large Hispanic population. The data was collected by two ABC Project Facilitators from each practice during a 12-month period including Key Informant Interviews (all staff members), MAP (Multi-method Assessment Process), and Practice Facilitation field notes. This data was used to evaluate leadership styles, management within the practice, and intervention tools that were implemented. The chief steps will be (1) to analyze if the leader-member relations contribute to the type of quality improvement strategy or strategies selected (2) to investigate if leader-position power contributes to the number of strategies selected and the type of strategy selected (3) and to explore whether the task structure varies across the four primary care practices.^ The research found that involving more members of the clinic staff in decision-making, building bridges between organizational staff and clinical staff, and task structure are all associated with the direct influence on the number and type of quality improvement strategies implemented in primary care practice.^ Although this research only investigated leadership styles of four different practices, it will offer future guidance on how to establish the priorities and implementation of quality improvement strategies that will have the greatest impact on patient care improvement. ^

Do Things Change in Therapy That Are Not Measured By Self-report Instruments?

This study investigates a new way of assessing change in psychotherapy, with the goal of decreasing the schism in the field of psychology between research and clinical practice. Change in psychotherapy was assessed in clients presenting with depressive symptoms who were seeking therapy at the Professional Psychology Center (PPC) at the University of Denver. Prior to beginning treatment, the subjects completed the Beck Depression Inventory- II (BDI-II) and the Symptom Checklist-90-R (SCL-90), and were also assessed by independent clinicians using the Shedler-Westen Assessment Procedure II (SWAP-II). Six to nine months later, after completing at least 12 psychotherapy sessions (range 12-21 sessions), the assessment procedure was repeated.There were no significant differences pre- to post-treatment on any measure. However, two subjects in the sample appeared to benefit from treatment, as assessed by both the self-report measures and the SWAP-II. The findings for these two subjects suggest that the SWAP-II can provide a greater depth of understanding about what can change in therapy than self-report measures alone. Possible reasons for the lack of treatment effects in the larger sample are discussed.

Using protocols in ICU practice. Engaging the staff.

Aims/Purpose: Protocols are evidenced-based structured guides for directing care to achieve improvements. But translating that evidence into practice is a major challenge. It is not acceptable to simply introduce the protocol and expect it to be adopted and lead to change in practice. Implementation requires effective leadership and management. This presentation describes a strategy for implementation that should promote successful adoption and lead to practice change.
Presentation description: There are many social and behavioural change models to assist and guide practice change. Choosing a model to guide implementation is important for providing a framework for action. The change process requires careful thought, from the protocol itself to the policies and politics within the ICU. In this presentation, I discuss a useful pragmatic guide called the 6SQUID (6 Steps in QUality Intervention Development). This was initially designed for public health interventions, but the model has wider applicability and has similarities with other change process models. Steps requiring consideration include examining the purpose and the need for change; the staff that will be affected and the impact on their workload; and the evidence base supporting the protocol. Subsequent steps in the process that the ICU manager should consider are the change mechanism (widespread multi-disciplinary consultation; adapting the protocol to the local ICU); and identifying how to deliver the change mechanism (educational workshops and preparing staff for the changes are imperative). Recognising the barriers to implementation and change and addressing these locally is also important. Once the protocol has been implemented, there is generally a learning curve before it becomes embedded in practice. Audit and feedback on adherence are useful strategies to monitor and sustain the changes.
Conclusion: Managing change successfully will promote a positive experience for staff. In turn, this will encourage a culture of enthusiasm for translating evidence into practice.

Professional conversations : a new approach to professional learning in ECEC

In 2009, Australia celebrated the introduction of a national Early Years Learning Framework. This is a critical component in a series of education reforms designed to support quality pedagogy and practice in early childhood education and care (ECEC) and successful transition to school. As with any policy change, success in real terms relies upon building shared understanding and the capacity of educators to apply new knowledge and support change and improved practice within their service. With these outcomes in mind, a collaborative research project is investigating the efficacy of a new approach to professional learning in ECEC: the professional conversation. This paper reports on the trial and evaluation of a series of professional conversations on the Early Years Learning Framework, and their capacity to promote collaborative reflective practice, shared understanding, and improved practice in ECEC. The paper details the professional conversation approach, key challenges and critical success factors, and the learning outcomes for conversation participants. Findings support the efficacy of this approach to professional learning in ECEC, and its capacity to support policy reform and practice change in ECEC.

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.

Wet tropics reef rescue impact report 2009

The Wet Tropics region has a unique water asset and is also considered a priority region for the improvement of water quality entering the Great Barrier Reef due to a combination of high rainfall, intensive agricultural use, urban areas and the proximity of valuable reef assets to the coast. Agricultural activities are one of many identified threats to water quality and water flows in the Wet Tropics in terms of sediment and pollutant-related water quality decline. Information describing the current state of agricultural management practices across the region is patchy at best. Based on the best available information on agricultural management practices in the Wet Tropics in 2008, it is clear that opportunities exist to improve nutrient, sediment and pesticide management practice to reduce the impact on the water asset and the Great Barrier Reef. Based on current understandings of practices and the relationship between practices and reef water quality, the greatest opportunities for improved water quality are as follows: · nutrients – correct rate and the placement of fertilisers; · pesticides – improve weed control planning, herbicide rates and calibration practice; and · soil and sediment – implement new farming system practices. The 2008-09 Reef Rescue program sought to accelerate the rate of adoption of improved management practices and through Terrain invested $6.8M in the 2008-09 year for: · landholder water quality improvement incentive payments; · cross regional catchment repair of wetlands and riparian lands in areas of high sediment or nutrient loss; and · partnerships in the region to lever resources and support for on-ground practice change. The program delivered $3,021,999 in onground incentives to landholders in the Wet Tropics to improve farm practices from D or C level to B or A level. The landholder Water Quality Incentives Grants program received 300 individual applications for funding and funded 143 individual landholders to implement practice change across 36,098 ha of farm land. It is estimated that the Reef Rescue program facilitated practice change across 21% of the cane industry, and 20% of the banana industry. The program levered an additional $2,441,166 in landholder cash contributions and a further $907,653 in non-cash in-kind contributions bringing the total project value of the landholder grants program in the Wet Tropics to $6,370,819. Most funded projects targeted multiple water quality objectives with a focus on nutrient and sediment reduction. Of the 143 projects funded, 115 projects addressed nutrient management either as the primary focus or in combination with strategies that targeted other water quality objectives. Overall, 82 projects addressed two or more water quality targets. Forty-five percent of incentive funds were allocated to new farming system practices (direct drill legumes, zonal tillage equipment, permanent beds, min till planting equipment, GPS units, laser levelling), followed by 24% allocated to subsurface fertiliser applicators (subsurface application of fertiliser using a stool splitter or beside the stool, at the correct Six Easy Steps rate). As a result, Terrain estimates that the incentive grants achieved considerable reductions in nitrogen, phosphorus, sediment and pesticide loads. The program supported nutrient management training of 167 growers managing farms covering over 20% of the area harvested in 2008, and 18 industry advisors and resellers. This resulted in 115 growers (155 farms) developing nutrient management plans. The program also supported Integrated Weed Management training of 80 growers managing farms covering 8% of the area harvested in 2008, and 6 industry advisors and resellers. This report, which draws on the best available Reef Rescue Management Monitoring, Evaluation, Reporting, and Improvement (MERI) information to evaluate program performance and impact on water quality outcomes, is the first in a series of annual reports that will assess and evaluate the impact of the Reef Rescue program on agricultural practices and water quality outcomes. The assessment is predominantly focused on the cane industry because of data availability. In the next stage, efforts will expand to: · improve practice data for the banana and grazing industry; · gain a better understanding of the water quality trends and the factors influencing them in the Wet Tropics; in particular work will focus on linking the results of the Paddock to Reef monitoring program and practice change data to assess program impact; · enhance estimations of the impact of practice change on pollutant loads from agricultural land use; · gain a better understanding of the extent of ancillary practice (change not directly funded) resulting from Reef Rescue training/ education/communication programs; and · provide a better understanding of the economic cost of practice change across the Wet Tropics region. From an ecological perspective, water quality trends and the factors that may be contributing to change, require further investigation. There is a critical need to work towards an enhanced understanding of the link between catchment land management practice change and reef water quality, so that reduced nutrient, sediment, and pesticide discharge to the Great Barrier Reef can be quantified. This will also assist with future prioritisation of grants money to agricultural industries, catchments and sub catchments. From a social perspective, the program has delivered significant water quality benefits from landholder education and training. It is believed that these activities are giving landholders the information and tools to implement further lasting change in their production systems and in doing so, creating a change in attitude that is supportive and inclusive of Natural Resource Management (NRM). The program in the Wet Tropics has also considerably strengthened institutional partnerships for NRM, particularly between NRM and industry and extension organisations. As a result of the Reef Rescue program, all institutions are actively working together to collectively improve water quality. The Reef Rescue program is improving water quality entering the Great Barrier Reef Lagoon by catalysing substantial activity in the Wet Tropics region to improve land management practices and reduce the water quality impact of agricultural landscapes. The solid institutional partnerships between the regional body, industry, catchment and government organisations have been fundamental to the successful delivery of the landholder grant and catchment rehabilitation programs. Landholders have generally had a positive perception and reaction to the program, its intent, and the practical, focused nature of grant-based support. Demand in the program was extremely high in 2008-09 and is expected to increase in 2009-2010.

Positioning the nursing librarian on the wards: nursing grand rounds with a difference

The concept nursing grand rounds (NGR) has been reported in the nursing literature since the 1960s. Many of the reported initiatives are based on a presentation forum in the manner of medical grand rounds, as an approach to undergraduate education, or as a means to monitor patients. Among the points of difference in the design of the pilot project undertaken in a busy surgical ward to investigate the effectiveness of NGR in increasing nurses work satisfaction was the inclusion of the nursing librarian as an integral part of the NGR team and processes which previously has not reported in the literature. The nursing librarian’s role was to search the literature and find the best evidence on the predetermined patient topic prior to the NGR to enable the nurse presenting to integrate the research findings into the presentation of the patient. The nursing librarian attended each NGR and commented where appropriate on the level of evidence. Nurses discussed current practice and the impact the retrieved literature would have on patient care comparing best practice with current practice. Outcomes of this project include in some cases change in practice, change in culture where NGRs are now embedded into ward culture, NGR extended to other wards, enthusiasm for EBP, the initiation of a “super searcher” model where the nursing librarian is more of a consultant and develops the searching skills of nominated nurses who become the resource on the ward.

Improving the outcomes of foot and ankle surgery. Professional impact of the Australasian College of Podiatric Surgeons' audit tool

Background Surgery is an example of expanded practice scope that enhances podiatry and incorporates inter-professional collaboration. By 2050 demand for foot and ankle procedures is predicted to rise nationally by 61.9%. Performance management of this increase motivated the development of an online audit tool. Developed in collaboration with the Australasian College of Podiatric Surgeons (ACPS), the ACPS audit tool provides real-time data capture and reporting. It is the first audit tool designed in Australia to support and improve the outcomes of foot and ankle surgery. Methods Audit activity in general, orthopaedic, plastic and podiatric surgery was examined using a case study design. Audit participation enablers and barriers were explored. Case study results guided a Delphi survey of international experts experienced or associated with foot and ankle surgery. Delphi survey-derived consensus informed modification of a generic data set from the Royal Australasian College of Surgeons (RACS). Based on the Delphi survey findings the ACPS online audit tool was developed and piloted. Reliability and validity of data entry and usability of this new tool was then assessed with an online survey. Results The case study found surgeon attitudes and behaviours positively impacted audit participation, and also indicated that audit data should be: (1) available in real time, (2) identify practice change, (3) applicable for safety and quality management, and; (4) useful for peer review discussion. The Delphi process established consensus on audit variables to be captured, including the modified RACS generic data set. 382 cases of foot and ankle surgery were captured across 3 months using the new tool. Data entry was found to be valid and reliable. Real-time outcome reporting and practice change identification impacted positively on safety and quality management and assisted peer review discussion. An online survey showed high levels of usability. Conclusions Surgeon contribution to audit tool development resulted in 100% audit participation. The data from the ACPS audit tool supported the ACPS submission to the Medical Services Advisory Committee to list podiatric surgery under Medicare, an outcome noted by the Federal Minister of Health.

Improving knowledge and practices in fresh produce chains

A successful supply chain must delivery the right product, value and satisfaction to the end customer, and profitability for its participants. Critical to getting the product right is the practices used to produce and maintain product quality through the supply chain from production to sale to the end customer. This paper describes the approach used by a R&D team to add value to supply chains through improving knowledge and practices. The desired outcome is better produce quality for consumers and more control and less wastage for chain participants. The team worked with specific supply chains to identify areas for improvement and to develop, test and implement improved practices. The knowledge gained was communicated to the industry to gain wider adoption of results. Three conditions were identified as critical for practice change - motivation, knowledge, and capacity for change. For improvement in practices to occur, a business must be motivated and have the knowledge and capacity to improve. Two case studies of working with Australian supply chains (mango and melons) are presented to illustrate our participatory methodology. A key activity is monitoring produce quality and handling practices and conditions to demonstrate to participants the points where quality deterioration occurs in the supply chain. This participatory approach is successful because working with supply chain participants generates knowledge and solutions to real problems. It enables the participants to observe the effect of handling practices and conditions on produce quality, gain knowledge and assess the benefits of improvements. Where existing knowledge is not present, research is conducted to fill the knowledge gaps. IV International Conference on Managing Quality in Chains - The Integrated View on Fruits and Vegetables Quality

Evaluation of an intervention for patients with alcohol-related injuries: results of a mixed methods study

Objective: To explore the effect of education and training on the delivery of alcohol screening and brief intervention and referral to high-risk patients in a hospital setting. Main outcome measures included; delivery of training; practice change in relation to staff performing alcohol screening, brief intervention and referrals. Methods: Observational study design using mixed methods set in a tertiary referral hospital. Pre-post assessment of medical records and semi-structured interviews with key informants. Results: Routine screening for substance misuse (9% pre / 71.4% post) and wellbeing concerns (6.6% pre / 15 % post) was more frequent following the introduction of resources and staff participation in educational workshops. There was no evidence of a concomitant increase in delivery of brief intervention or referrals to services. Implementation challenges, including time constraints and staff attitudes, and enablers such as collaboration and visible pathways, were identified. Conclusion: Rates of patient screening increased, however barriers to delivery of brief intervention and referrals remained. Implementation strategies targeting specific barriers and enablers to introducing interventions are both required to improve the application of secondary prevention for patients in acute settings. Implications: Educational training, formalised liaison between services, systematised early intervention protocols, and continuous quality improvement processes will progress service delivery in this area.

Action learning in partnership with Landcare and catchment management groups to support increased pasture sowings in southern inland Queensland

The incorporation of sown pastures as short-term rotations into the cropping systems of northern Australia has been slow. The inherent chemical fertility and physical stability of the predominant vertisol soils across the region enabled farmers to grow crops for decades without nitrogen fertiliser, and precluded the evolution of a crop–pasture rotation culture. However, as less fertile and less physically stable soils were cropped for extended periods, farmers began to use contemporary farming and sown pasture technologies to rebuild and maintain their soils. This has typically involved sowing long-term grass and grass–legume pastures on the more marginal cropping soils of the region. In partnership with the catchment management authority, the Queensland Murray–Darling Committee (QMDC) and Landcare, a pasture extension process using the LeyGrain™ package was implemented in 2006 within two Grain & Graze projects in the Maranoa-Balonne and Border Rivers catchments in southern inland Queensland. The specific objectives were to increase the area sown to high quality pasture and to gain production and environmental benefits (particularly groundcover) through improving the skills of producers in pasture species selection, their understanding and management of risk during pasture establishment, and in managing pastures and the feed base better. The catalyst for increasing pasture sowings was a QMDC subsidy scheme for increasing groundcover on old cropping land. In recognising a need to enhance pasture knowledge and skills to implement this scheme, the QMDC and Landcare producer groups sought the involvement of, and set specific targets for, the LeyGrain workshop process. This is a highly interactive action learning process that built on the existing knowledge and skills of the producers. Thirty-four workshops were held with more than 200 producers in 26 existing groups and with private agronomists. An evaluation process assessed the impact of the workshops on the learning and skill development by participants, their commitment to practice change, and their future intent to sow pastures. The results across both project catchments were highly correlated. There was strong agreement by producers (>90%) that the workshops had improved knowledge and skills regarding the adaptation of pasture species to soils and climates, enabling a better selection at the paddock level. Additional strong impacts were in changing the attitudes of producers to all aspects of pasture establishment, and the relative species composition of mixtures. Producers made a strong commitment to practice change, particularly in managing pasture as a specialist crop at establishment to minimise risk, and in the better selection and management of improved pasture species (particularly legumes and the use of fertiliser). Producers have made a commitment to increase pasture sowings by 80% in the next 5 years, with fourteen producers in one group alone having committed to sow an additional 4893 ha of pasture in 2007–08 under the QMDC subsidy scheme. The success of the project was attributed to the partnership between QMDC and Landcare groups who set individual workshop targets with LeyGrain presenters, the interactive engagement processes within the workshops themselves, and the follow-up provided by the LeyGrain team for on-farm activities.