The provision of patient personal hygiene in the intensive care unit : a descriptive exploratory study of bed-bathing practice

Background/objectives The provision of the patient bed-bath is a fundamental nursing care activity yet few quantitative data and no qualitative data are available on registered nurses’ (RNs) clinical practice in this domain in the intensive care unit (ICU). The aim of this study was to describe ICU RNs current practice with respect to the timing, frequency and duration of the patient bed-bath and the cleansing and emollient agents used. Methods The study utilised a two-phase sequential explanatory mixed method design. Phase one used a questionnaire to survey RNs and phase two employed semi-structured focus group (FG) interviews with RNs. Data was collected over 28 days across four Australian metropolitan ICUs. Ethical approval was granted from the relevant hospital and university human research ethics committees. RNs were asked to complete a questionnaire following each episode of care (i.e. bed-bath) and then to attend one of three FG interviews: RNs with less than 2 years ICU experience; RNs with 2–5 years ICU experience; and RNs with greater than 5 years ICU experience. Results During the 28-day study period the four ICUs had 77.25 beds open. In phase one a total of 539 questionnaires were returned, representing 30.5% of episodes of patient bed-baths (based on 1767 bed occupancy and one bed-bath per patient per day). In 349 bed-bath episodes 54.7% patients were mechanically ventilated. The bed-bath was given between 02.00 and 06.00 h in 161 episodes (30%), took 15–30 min to complete (n = 195, 36.2%) and was completed within the last 8 h in 304 episodes (56.8%). Cleansing agents used were predominantly pH balanced soap or liquid soap and water (n = 379, 71%) in comparison to chlorhexidine impregnated sponges/cloths (n = 86, 16.1%) or other agents such as pre-packaged washcloths (n = 65, 12.2%). In 347 episodes (64.4%) emollients were not applied after the bed-bath. In phase two 12 FGs were conducted (three FGs at each ICU) with a total of 42 RN participants. Thematic analysis of FG transcripts across the three levels of RN ICU experience highlighted a transition of patient hygiene practice philosophy from shades of grey – falling in line for inexperienced clinicians to experienced clinicians concrete beliefs about patient bed-bath needs. Conclusions This study identified variation in process and products used in patient hygiene practices in four ICUs. Further study to improve patient outcomes is required to determine the appropriate timing of patient hygiene activities and cleansing agents used to improve skin integrity.

Attitudes towards consumer transgressions in the marketplace

A sample of 815 adults drawn from the general American population provided their perception of the appropriateness of 12 questionable consumer actions in the marketplace. The scenarios investigated ranged from illegal actions such as inflating one’s losses when filing an insurance claim to actions that while not illegal, may raise questions of ethics. The 12 scenarios exhibited a wide range of mean responses on the six-point scale thereby supporting an often stated premise that consumer ethics is situational in nature. An array of commonly employed demographic questions was also included on the Internet-based survey, and differences of opinion were documented across the various demographic segments.

Getting lost in the field : the unpredictable nature of fieldwork with young people

This chapter focuses on the unpredictable nature of fieldwork with young offenders, specifically with those in a marginalised context. We begin by recounting our experiences working with young people who have had contact with criminal justice processes, particularly those who are the subject of extreme levels of official social control. We then turn to a discussion of the challenges associated with the unpredictable nature of fieldwork, specifically the difficulties associated with negotiating access with gatekeepers and negotiating with young people. We also discuss specific challenges with the research ethics governance of ethically sensitive research in this context (e.g. interviewing young people about offending behaviour). Finally, we recount our experiences in working these young people, with a focus on ‘the grunt’: that is, drawing out young peoples’ stories in interviews. We conclude with some reflections on the need to develop systematic instruction in qualitative work in this specific context.

Professions without borders : global ethics and the international rule of law

The emergence of strong sovereign states after the Treaty of Westphalia turned two of the most cosmopolitan professions (law and arms) into two of the least cosmopolitan. Sovereign states determined the content of the law within their borders – including which, if any, ecclesiastical law was to be applied; what form of economic regulation was adopted; and what, if any, international law applied. Similarly, states sought to ensure that all military force was at their disposal in national armies. The erosion of sovereignty in a post-Westphalian world may significantly reverse these processes. The erosion of sovereignty is likely to have profound consequences for the legal profession and the ethics of how, and for what ends, it is practised. Lawyers have played a major role in the civilization of sovereign states through the articulation and institutionalisation of key governance values – starting with the rule of law. An increasingly global profession must take on similar tasks. The same could be said of the military. This essay will review the concept of an international rule of law and its relationship to domestic conceptions and outline the task of building the international rule of law and the role that lawyers can and should play in it.

Entry into Valhalla : contextualising the learning of legal ethics through the use of Second Life machinima

An ability to recognise and resolve ethical dilemmas was identified by the Australian Law Reform Commission as one of the ten fundamental lawyering skills. While the ‘Priestley 11’ list of areas of law required to qualify for legal practice includes ethics and professional responsibility, the commitment to ethics learning in Australian law schools has been far from uniform. The obligation imposed by the Priestley 11 is frequently discharged by a traditional teaching and learning approach involving lectures and/or tutorials and focusing on the content of the formal rules of professional responsibility. However, the effectiveness of such an approach is open to question. Instead, a practical rather than a theoretical approach to the teaching of legal ethics is required. Effective final-year student learning of ethics may be achieved by an approach which engages students, enabling them to appreciate the relevance of what they are learning to the real world and facilitating their transition from study to their working lives. Entry into Valhalla comprises a suite of modules featuring ‘machinima’ (computer-generated imagery) created using the Second Life virtual environment to contextualise otherwise abstract concepts. It provides an engaging learning environment which enables students to obtain an appreciation of ethical responsibility in a real-world context and facilitates understanding and problem-solving ability.

Palliative care, double effect and the law in Australia

Care and decision-making at the end of life that promotes comfort and dignity is widely endorsed by public policy and the law. In ethical analysis of palliative care interventions that are argued potentially to hasten death, these may be deemed to be ethically permissible by the application of the doctrine of double effect, if the doctor’s intention is to relieve pain and not cause death. In part because of the significance of ethics in the development of law in the medical sphere, this doctrine is also likely to be recognized as part of Australia’s common law, although hitherto there have been no cases concerning palliative care brought before a court in Australia to test this. Three Australian States have, nonetheless, created legislative defences that are different from the common law with the intent of clarifying the law, promoting palliative care, and distinguishing it from euthanasia. However, these defences have the potential to provide less protection for doctors administering palliative care. In addition to requiring a doctor to have an appropriate intent, the defences insist on adherence to particular medical practice standards and perhaps require patient consent. Doctors providing end-of-life care in these States need to be aware of these legislative changes. Acting in accordance with the common law doctrine of double effect may not provide legal protection. Similar changes are likely to occur in other States and Territories as there is a trend towards enacting legislative defences that deal with the provision of palliative care.

Teaching English : some remarks on the emergence of the sympathetic teacher in the English classroom

The chapter explores the concept of the teacher-student relationship within the English classroom and proposes that this relationship has a specific purpose in building a civil society by inculcating practices of self-reflection, empathy and ethics. The topic is explored through the example of teaching Australian literature, specifically, Tim Winton’s Lockie Leonard, Human Torpedo to secondary school students. Ian Hunter’s work on literature education and the construction of socio-ethical practices provides a conceptual framework for the chapter.

Motivation : staying in the achievement zone with personal integrity

This paper was presented at orientation, to a select group of Business Faculty First Year students accepted into the "Corporate Partners in Excellence Programme" (CPIE). It discusses some of the strategies for continuing as high performing students in University studies whilst at the same time maturing into successful, ethical professionals with a social and environmental conscience.

Saying sorry in the 21st century : public apologies in a digital world

The public apology to the Forgotten Australians in late 2009 was, for many, the culmination of a long campaign for recognition and justice. The groundswell for this apology was built through a series of submissions which documented the systemic institutionalised abuse and neglect experienced by the Forgotten Australians that has resulted, for some, in life-long disadvantage and marginalisation. Interestingly it seems that rather than the official documents being the catalyst for change and prompting this public apology, it was more often the personal stories of the Forgotten Australians that resonated and over time drew out quite a torrent of support from the public leading up to, during and after the public apology, just as had been the case with the ‘Stolen Generation.’ Research suggests (cite) that the ethics of such national apologies only make sense if their personal stories are seen as a collective responsibility of society, and only carry weight if we understand and seek to Nationally address the trauma experienced by such victims. In the case of the Forgotten Australians, the National Library of Australia’s Forgotten Australians and Former Child Migrants Oral History Project and the National Museum’s Inside project demonstrate commitment to the digitisation of the Forgotten Australians’ stories in order to promote a better public understanding of their experiences, and institutionally (and therefore formally) value them with renewed social importance. Our project builds on this work not by making or collecting more stories, but by examining the role of the internet and digital technologies used in the production and dissemination of individuals’ stories that have already been created during the period of time between the tabling of the senate inquiry, Children in Institutional Care (1999 or 2003?) and a formal National apology being delivered in Federal Parliament by PM Kevin Rudd (9 Nov, 2009?). This timeframe also represents the emergent first decade of Internet use by Australians, including the rapid easily accessible digital technologies and social media tools that were at our disposal, along with the promises the technology claimed to offer — that is that more people would benefit from the social connections these technologies allegedly were giving us.

The Wood Royal Commission : a case study in the slippery slope from unethical conduct to criminal acts

Over the last two and a half decades, corruption in the police service in Australia has come under increased official and public scrutiny. Numerous scandals involving police officers has caused concerned about the integrity and ethics within the Police Service. This paper examines the Wood Royal Commission, specifically looking at testimony from Trevor Haken. This paper provides insights into the nature of police corruption as well as the process or ‘slippery slope’ corrupt officers go through. This paper also contributed to the existing literature by providing knowledge into the types of corruption used by police officers in real-life situations, and deepening understanding of how corruption emerges and why. It specifically confirms the literature on slippery slope arguments about police corruption and the role of trust in building a corrupt career. The paper contributes to the existing literature by providing insights into the nature of corruption used by police officers in real-life situations, and deepens the understanding of the process of corruption. The findings also contribute to our understanding that corruption is not just an individual incident but rather a result of reoccurring incidents that are generated by the nature of work, organizational structure and society in relation to corruption.

Nourishing or polluting : redefining the role of waste in the fashion system

Waste is intrinsic to the fashion system. Fashion is predicated on built-in obsolescence, and as such outmoded garments are rapidly discarded to charity shops or landfill. However, the story of fashion is also one of abundance and extravagance in design ideas. Every season there are new design details – prints, embroidery, embellishments, shapes and textures. This excess of ideas is in itself another form of waste, albeit one that is culturally nourishing. The grave of a fashion garment may also be the grave of a season’s research and creativity. This paper compares the tangible waste of the industry with its intangible waste, namely fashion’s creativity and cultural excess. Fashion’s excess and abundance of trends and ideas makes any move to curb the environmental impact difficult. For all practitioners of fashion – whether designers or consumers – the waste and excess inherent in the fashion system is a difficult ethical terrain to negotiate. However, inverting the wasteful phases of the production cycle can help reframe waste from pollution to a source of nourishment for future practice. While creative excesses of designers may be ‘wasted’ after a season, fashion styles and tropes are recycled and reinvented, with the once passé styles and design ideas from previous years revalorized and returned into the fashion system. Similarly, material garments acquire new value through entering or re-entering the second hand or vintage markets. Design processes can utilise pre or post-consumer textile waste, or eliminate waste through design. In these processes, waste becomes the primary source of nourishment for future fashion cycles.