Psychosocial outcomes of Hong Kong Chinese diagnosed with acute coronary syndromes: a prospective repeated measures study.

BACKGROUND: Western studies have suggested that emotional stress and distress impacted on the morbidity and mortality in people following acute coronary events. Symptoms of anxiety and depression have been associated with re-infarction and death, prolonged recovery and disability and depression may precipitate the client's low self-esteem. This study examined perceived anxiety, depression and self-esteem of Hong Kong Chinese clients diagnosed with acute coronary syndrome (ACS) over a 6-month period following hospital admission. OBJECTIVES: To examine: DESIGN: A prospective, repeated measures design with measures taken on two occasions over a 6-month period; (1) within the 1st week of hospital admission following the onset of ACS and (2) at 6 months follow up. SETTING AND PARTICIPANTS: Convenient sample of 182 voluntary consented clients admitted with ACS to a major public hospital in Hong Kong who could communicate in Chinese, complete questionnaires, cognitive intact, and were haemodynamically stable and free from acute chest pain at the time of interview. METHODS: Baseline data were obtained within 1 week after hospital admission. The follow-up data was collected 6 months after hospital discharge. The Chinese version of the Hospital Anxiety and Depression Scale (HADS), State Self-esteem Scale (SSES), and Rosenberg's Self-Esteem Scale (RSES) were used to assess anxiety and depression, state self-esteem, and trait self-esteem, respectively. RESULTS: Findings suggested gender differences in clients' perception in anxiety, depression and self-esteem. Improvements in clients' perception of these variables were evident over the 6-month period following their acute coronary events. CONCLUSION: The study confirmed the western notion that psychosocial problems are common among coronary clients and this also applies to Hong Kong Chinese diagnosed with ACS. Further studies to explore effective interventions to address these psychosocial issues are recommended.

The core role of the nurse practitioner: practice, professionalism and clinical leadership.

AIM: To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. BACKGROUND: Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally. METHOD: This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data. FINDINGS: The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care. CONCLUSION: A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide new perspectives to inform the international debate about this extended level of nursing practice. RELEVANCE TO CLINICAL PRACTICE: The findings from this research have the potential to achieve a standardised approach and internationally consistent nomenclature for the nurse practitioner role.

Do clients with acquired brain injury use the splints prescribed by occupational therapists? A descriptive study

Clients with acquired brain injury often demonstrate hypertonicity and decreased function in their upper limbs, requiring appropriate intervention. Splinting is one of the intervention methods that is widely used to address these issues. Literature shows that some clients are not using splints following fabrication. However, there is a paucity of research about the factors that influence clients to use or not use splints. This study aims to investigate these influential factors for clients with upper limb hypertonicity. Two survey tools including therapist and client questionnaires were developed and completed by both therapists and clients. Six therapists and 14 clients participated in this study and completed the relevant questionnaires. The results illustrate that most clients (13 out of 14) were continuing to use their splints four weeks following discharge from hospital. The main goals of choosing splints for both therapists and clients were prevention of contracture and deformity. The most indicated client reasons for adhering to the splint wearing program were therapist-related factors including clients’ trust and reliance on their therapists. Further reasons for clients implementing the recommended splint-wearing program and clinical implications are discussed.

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.

Marketing VM services to achieve competitive advantage in the Malaysian Construction Sector

Value Management (VM) has been proven to provide a structured framework, together with supporting tools and techniques that facilitate effective decision-making in many types of projects, thus achieving ‘best value’ for clients. It is identified at International level as a natural career progression for the construction service provider and as an opportunity in developing leading-edge skills. The services offered by contractors and consultants in the construction sector have been expanding. In an increasingly competitive and global marketplace, firms are seeking ways to differentiate their services to ever more knowledgeable and demanding clients. The traditional demarcations have given way, and the old definition of what contractors, designers, engineers and quantity surveyors can, and cannot do in terms of their market offering has changed. Project management, design and cost and safety consultancy services, are being delivered by a diverse range of suppliers. Value management services have been developing in various sectors in industry; from manufacturing to the military and now construction. Given the growing evidence that VM has been successful in delivering value-for-money to the client, VM would appear to be gaining some momentum as an essential management tool in the Malaysian construction sector. The recently issued VM Circular 3/2009 by the Economic Planning Unit Malaysia (EPU) possibly marks a new beginning in public sector client acceptance on the strength of VM in construction. This paper therefore attempts to study the prospects of marketing the benefits of VM by construction service providers, and how it may provide an edge in an increasingly competitive Malaysian construction industry.

Sustainability performance of construction : conceptual models of satisfaction levels in construction projects

In general, the performance of construction projects, including their sustainability performance, does not meet optimal expectations. One aspect of this is the performance of the participants who are independent and make a significance impact on overall project outcomes. Of these participants, the client is traditionally the owner of the project, the architect or engineer is engaged as the lead designer and a contractor is selected to construct the facilities. Generally, the performance of the participants is gauged by considering three main factors, namely, time, cost and quality. As the level of satisfaction is a subjective issue, it is rarely used in the performance evaluation of construction work. Recently, various approaches to the measurement of satisfaction have been made in an attempt to determine the performance of construction project outcomes - for instance, client satisfaction, customer satisfaction, contractor satisfaction, occupant satisfaction and home buyer satisfaction. These not only identify the performance of the construction project but are also used to improve and maintain relationships. In addition, these assessments are necessary for the continuous improvement and enhanced cooperation of participants. The measurement of satisfaction levels primarily involves expectations and perceptions. An expectation can be regarded as a comparative standard of different needs, motives and beliefs, while a perception is a subjective interpretation that is influenced by moods, experiences and values. This suggests that the disparity between perceptions and expectations may possibly be used to represent different levels of satisfaction. However, this concept is rather new and in need of further investigation. This chapter examines the methods commonly practised in measuring satisfaction levels today and the advantages of promoting these methods. The results provide a preliminary review of the advantages of satisfaction measurement in the construction industry and recommendations are made concerning the most appropriate methods to use in identifying the performance of project outcomes.

Applying SVMs and weight-based factor analysis to unsupervised adaptation for speaker verification

This paper presents an extended study on the implementation of support vector machine(SVM) based speaker verification in systems that employ continuous progressive model adaptation using the weight-based factor analysis model. The weight-based factor analysis model compensates for session variations in unsupervised scenarios by incorporating trial confidence measures in the general statistics used in the inter-session variability modelling process. Employing weight-based factor analysis in Gaussian mixture models (GMM) was recently found to provide significant performance gains to unsupervised classification. Further improvements in performance were found through the integration of SVM-based classification in the system by means of GMM supervectors. This study focuses particularly on the way in which a client is represented in the SVM kernel space using single and multiple target supervectors. Experimental results indicate that training client SVMs using a single target supervector maximises performance while exhibiting a certain robustness to the inclusion of impostor training data in the model. Furthermore, the inclusion of low-scoring target trials in the adaptation process is investigated where they were found to significantly aid performance.

Factors contributing to ethical issues in project procurement planning : a case study in Malaysia

The construction industry plays a substantial role in a country’s national economy, irrespective of the country’s levels of economic development. The Malaysian Government has given a much needed boost to the country’s construction projects under the 9th Malaysian Plan where a total of 880 projects worth RM15billion (US$48billion) is to be tendered (The Star, 2006). However, Malaysia has not escaped the problems of project failure. In 2005, 17.3% of 417 Malaysian government contracts projects were considered “sick”. Project procurement is one of the most important stages of project delivery. Even though ethics in project procurement has been identified as one of the contributors to project failure, it has not been systematically studied before from the perspective of client in Malaysia. The aim of this paper is to present an exploration to the ethical issues in project procurement in Malaysian public sector projects. By exploring ethical issues from client perspective, this could provide an ethical standpoint for the project life cycle and could maintain a good affiliation between the clients and the customers. It is expected that findings from this review will be somewhat representative of other developing countries.

Perceptions of the psychological well-being and care of older home care clients : clients and their carers

Aim. To explore and compare older home care clients’ (65+) and their professionals’ perceptions of the clients’ psychological well-being and care and to identify possible differences in these perceptions. Background. Psychological well-being is considered an important dimension of quality of life. With advancing age, older people require home care support to be able to remain in their own home. The main goal of care is to maximise their independence and quality of life. Design. Descriptive, survey design with questionnaire. Methods. A postal questionnaire was distributed to 200 older home care clients and 570 social and health care professionals in 2007. The total response rate was 63%. The questionnaire consisted of questions about clients’ psychological well-being and the provision of care by home care professionals. The differences in responses between clients and professionals were analysed using cross-tabulations, the Pearson Chi-Square Test and Fisher’s Exact Tests. Results. The professional group believed that their clients did not have plans for the future. They believed that their clients felt themselves depressed and suffering from loneliness significantly more often than the client group did. The client group were also significantly more critical of the care (motivating independent actions, physical, psychological and social care) they got from the professional group than how the professionals evaluated the care they gave. Conclusions. To be able to support older clients to continue living at home, professionals need to provide a service that meets client’s own perceptions and complex social and health care needs as well as personal sense of well-being. Relevance to clinical practice. The findings offer useful insights for the professional in planning and delivering appropriate home care services. A better understanding of differences between clients’ and professionals’ perceptions could lead to a better individualised care outcome.

Clients’ understanding of the role of nurse practitioners

Introduction: Nurse Practitioners (NPs) have an emerging role in the Australian healthcare system. However, there remains a dearth of available data about public understanding of the NP role. ---------- Aim: To evaluate clients’ understanding of the role of the NP and their satisfaction with education received, quality of care and NP knowledge and skill. ---------- Method: All authorised NPs working in a designated NP position in Western Australia and those working in three area health services in New South Wales (NSW) were invited to recruit five consecutive clients to complete the self-administered survey. ---------- Results: Thirty two NPs (NP response rate 93%) recruited 129 clients (client response rate 90%). Two thirds of clients (63%) were aware they were consulting an NP. The majority rated the following NP related outcomes as ‘excellent’ or ‘very good’: education provided (89%); quality of care (95%); and knowledge and skill (93%). Less than half reported an understanding that NPs could prescribe medications (40.5%) or interpret X-rays (33.6%). Clients of NPs practising in a rural or remote setting were more likely than those in an urban setting to have previously consulted an NP (p=0.005), and where applicable would to prefer to see a NP rather than a doctor (p=0.022). ---------- Discussion: Successful implementation and expansion of the NP role requires NP visibility in the community. Despite high levels of satisfaction more awareness of the scope of the NP role is required.

Conceptual models of satisfaction level in construction

It is recognized that, in general, the performance of construction projects does not meet optimal expectations. One aspect of this is the performance of each participant, which is interdependent and makes a significance impact on overall project outcomes. Of these, the client is traditionally the owner of the project, the architect or engineer is engaged as the lead designer and a contractor is selected to construct the facilities. Generally, the performance of the participants is gauged by considering three main factors, namely time, cost and quality. As the level of satisfaction is a subjective measurement, it is rarely used in the performance evaluation of construction work. Recently, various approaches to the measurement of satisfaction have been made in attempting to determine the performance of construction project outcomes – for instance client satisfaction, consultant satisfaction, contractor satisfaction, customer satisfaction and home buyer satisfaction. These not only identify the performance of the construction project, but are also used to improve and maintain relationships. In addition, these assessments are necessary for continuous improvement and enhanced cooperation between participants. The measurement of satisfaction levels primarily involves expectations and perceptions. An expectation can be regarded as a comparison standard of different needs, motives and beliefs, while a perception is a subjective interpretation that is influenced by moods, experiences and values. This suggests that the disparity between perceptions and expectations may be used to represent different levels of satisfaction. However, this concept is rather new and in need of further investigation. This paper examines the current methods commonly practiced in measuring satisfaction level and the advantages of promoting these methods. The results provided are a preliminary review of the advantages of satisfaction measurement in the construction industry and recommendations are made concerning the most appropriate methods for use in identifying the performance of project outcomes.

The impact of contractor’s characteristics in gauging level satisfaction

The outcomes of the construction projects can be evaluated in numerous ways. One method is to measure the satisfaction of participants as represented by the differences between their expectations and perceptions. This measurement is used widely in construction as it promises benefits, such as the improvement of product delivery, and enhances services quality by identifying some necessary changes. Commonly satisfaction measurement is gauged by evaluating the level of client satisfaction of construction performance. The measurement of customer satisfaction on the other hand, is based on the quality of the end product. This evaluation is used to encourage contractors to improve their performance to a required level and to ensure that the projects are delivered as expected- in terms of time, budget and quality. Several studies of performance measurement have indicated that contractor performance is still not satisfactory, as the outcome delivered is not as required (because of cost overruns, time overruns or because it is generally unsatisfactory). This drawback may be due to the contractors’ lack of expertise, motivation and/or satisfaction. The measurement of performance based on contractor satisfaction levels is still new and very few studies have yet taken place in the construction industry. This paper examines how the characteristics of a contracting organisation – namely its experience in the industry, background, past performance, size of organisation and financial stability- may influence its satisfaction levels with regards to project performance. Previous literature reviews and interviews are used as research tools in the preliminary investigation. The outcome is expected to present a basic understanding of contractor satisfaction measurement and its potential for improving the performance of project outcomes.

A conceptual framework for ethical decision making in project procurement

There is a lack of research which identifies the role of the public-sector client in relation to ethical practice in plan procurement. This paper discusses a conceptual framework for ethical decision making in project procurement, focusing on public sector clients within the Malaysian construction industry. A framework is proposed to ensure that effective ethical decision making strategies are deployed to ensure that plan procurement is carried out with a transparent process so that the public sector clients are able to adopt. The conceptual framework adopts various factors that contribute to ethical decision making at the early stage of procurement and consists of the procurement system, individual factors, project characteristics, and organizational culture as the internal factors and professional code of conduct and government policies as the external factors. This framework rationalizes the relationships between systems, psychology and organizational theory to form an innovative understanding of making ethical decisions in plan procurement. It is expected that this proposed framework will be useful as a foundation for identifying the factors that contribute to ethical decision making focusing on the planning stage of procurement process.