678 resultados para breastfeeding, breastmilk, paediatric nurse, knowledge, attitudes


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Injuries and deaths due to unsafe driving practices are a substantial health and socioeconomic burden to the community. Young socially disadvantaged males who are involved in a lifestyle of risky behaviour, crime and motor vehicle accidents seem unaffected by educational campaigns to improve safer driving. The aim is to develop a driving and social behavioural profile that may explain the lack of effectiveness of road safety advertising and suggest ways to refine educational strategies to reduce the risky lifestyle and associated harms among those most vulnerable, the 15-25 year olds. The procedure involved a quantitative and qualitative analysis through questionnaires, surveys and focus groups involving a comparison of populations (n = 668) by age, gender and socioeconomic status in three discrete Australian sites. Information gathered included issues related to road safety awareness, knowledge of advertising, personal and peer group attitudes as well as driving and life style history. The results indicate that within the community a highly visible profile of strong anti-social road safety activities by an educationally and economically disadvantaged sub-culture exists and this group seem impervious to road safety advertising and education initiatives. As the overall unsafe driving and risky antisocial behaviour is significant among 15-25 year olds within the community the solution is seen to be community based. A long-term (five to ten year) program has been posited; promoting community partnerships through consultative and local action committees at all levels creating locally designed formal and informal educational and mutual support programs.

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Background: Breastfeeding is the internationally accepted ideal in infant feeding. Ensuring mothers and babies receive optimal benefits, in both the short and long term, is dependent upon the successful establishment of breastfeeding in the first week. Many maternal and infant challenges can occur during the establishment of breastfeeding (Lactogenesis II). There are also many methods and devices (alternative techniques) which can be used to help, but the majority do not have an evidence-base. The mother.s self-confidence (self-efficacy) can be challenged by these unexpected circumstances, but understanding of the relationship is unclear. Method: This descriptive study used mail survey (including the Breastfeeding Self-Efficacy Scale . Short Form) to obtain the mother.s reports of their self-efficacy and their breastfeeding experience during the first week following birth, as well as actual use of alternative techniques. This study included all mothers of full term healthy singleton infants from one private hospital in Brisbane who began any breastfeeding. The data collection took place from November 2008 to February 2009. Ethical approval was granted from the research site and QUT Human Research Ethics Committee. Results: A total of 128 questionnaires were returned, a response rate of 56.9%. The sample was dissimilar to the Queensland population with regard to age, income, and education level, all of which were higher in this study. The sample was similar to the Queensland population in terms of parity and marital status. The rate of use of alternative techniques was 48.3%. The mean breastfeeding self-efficacy score of those who used any alternative technique was 43.43 (SD=12.19), and for those who did not, it was 58.32 (SD=7.40). Kruskal-Wallis analysis identified that the median self efficacy score for those who used alternative techniques was significantly lower than median self efficacy scores for those who did not use alternative techniques. The reasons women used alternative techniques varied widely, and their knowledge of alternative techniques was good. Conclusion: This study is the first to document breastfeeding self-efficacy of women who used alternative techniques to support their breastfeeding goals in the first week postpartum. An individualised clinical intervention to develop women.s self-efficacy with breastfeeding is important to assist mother/infant dyads encountering challenges to breastfeeding in the first week postpartum.

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This chapter will discuss a research project that identifies the skills, knowledge and attitudes of the m-librarian. Six library and information professionals engaged in the provision of m-library services throughout Australia were interviewed. Six themes emerged as being critical for the m-librarian: technology, personal traits, user focus, communication, collaboration, research and development. The research is significant because it establishes an open dialogue between current industry professionals, library science educators and the professional association on the evolving skills and knowledge required by information professional in a world of rapidly changing technology. This dialogue will guide the development of current and future education of library and information professionals.

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In the current era of global economic instability, business and industry have already identified a widening gap between graduate skills and employability. An important element of this is the lack of entrepreneurial skills in graduates. This Teaching Fellowship investigated two sides of a story about entrepreneurial skills and their teaching. Senior players in the innovation commercialisation industry, a high profile entrepreneurial sector, were surveyed to gauge their needs and experiences of graduates they employ. International contexts of entrepreneurship education were investigated to explore how their teaching programs impart the skills of entrepreneurship. Such knowledge is an essential for the design of education programs that can deliver the entrepreneurial skills deemed important by industry for future sustainability. Two programs of entrepreneurship education are being implemented at QUT that draw on the best practice exemplars investigated during this Fellowship. The QUT Innovation Space (QIS) focuses on capturing the innovation and creativity of students, staff and others. The QIS is a physical and virtual meeting and networking space; a connected community enhancing the engagement of participants. The Q_Hatchery is still embryonic; but it is intended to be an innovation community that brings together nascent entrepreneurial businesses to collaborate, train and support each other. There is a niche between concept product and business incubator where an experiential learning environment for otherwise isolated ‘garage-at-home’ businesses could improve success rates. The QIS and the Q_Hatchery serve as living research laboratories to trial the concepts emerging from the skills survey. The survey of skills requirements of the innovation commercialisation industry has produced a large and high quality data set still being explored. Work experience as an employability factor has already emerged as an industry requirement that provides employee maturity. Exploratory factor analysis of the skills topics surveyed has led to a process-based conceptual model for teaching and learning higher-order entrepreneurial skills. Two foundational skills domains (Knowledge, Awareness) are proposed as prerequisites which allow individuals with a suite of early stage entrepreneurial and behavioural skills (Pre-leadership) to further leverage their careers into a leadership role in industry with development of skills around higher order elements of entrepreneurship, management in new business ventures and progressing winning technologies to market. The next stage of the analysis is to test the proposed model through structured equation modelling. Another factor that emerged quickly from the survey analysis broadens the generic concept of team skills currently voiced in Australian policy documents discussing the employability agenda. While there was recognition of the role of sharing, creating and using knowledge in a team-based interdisciplinary context, the adoption and adaptation of behaviours and attitudes of other team members of different disciplinary backgrounds (interprofessionalism) featured as an issue. Most undergraduates are taught and undertake teamwork in silos and, thus, seldom experience a true real-world interdisciplinary environment. Enhancing the entrepreneurial capacity of Australian industry is essential for the economic health of the country and can only be achieved by addressing the lack of entrepreneurial skills in graduates from the higher education system. This Fellowship has attempted to address this deficiency by identifying the skills requirements and providing frameworks for their teaching.

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This study assessed the validity of a scale measuring psychologists' attitudes towards complementary and alternative therapies and compared the attitudes of psychologists with a previous sample of psychology students. The scale, derived from existing measures for medical professionals and previously tested on a sample of psychology students, was completed by practising psychologists (N = 122). The data were factor analysed, and three correlated subscales were identified, assessing the perceived importance of knowledge about available therapies, attitudes towards integration with psychological practice, and concerns about associated risks of use. This structure was similar, but not identical, to that found in a previous sample of psychology students; however, psychologists expressed more concern for risks associated with integration and were less likely to hold a positive attitude towards integration. This scale will be useful in gauging changes in psychologists' attitudes towards integrative practice over time.

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Over the past decade the discipline of nursing has been reviewing its practice, especially in relation to specialty areas. There has been an appreciation by nursing leaders that specialisation brings with it concerns related to a disuniting effect on the discipline and a fragmentation of nursing's traditional generalist practice. Accompanying these concerns is a debate over what is a specialty and how to define a specialist. This qualitative study drew upon a constructivist methodology, to explore how nurses, working in specialty areas, define and give meaning to their practice. Three groups of nurses (n=20) from the specialty of critical care were interviewed using a focus group technique. The data were analysed to build constructions of specialty practice. A distinct and qualitative difference was recognised in the practice behaviours of nurses working in the specialty area. The qualitatively different practice behaviours have been identified as ‘nursing-in-a-specialty’ and ‘specialist nurse’. Two constructions emerged to differentiate the skill behaviours, these were ‘practice’ and ‘knowledge’. The specialist nurse practices were based on two distinct types of practice, that of ‘discretion’ and ‘incorporation’. ‘Knowledge’ was constructed as a synthesis of propositional and practice knowledge.

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Summary Background The final phase of a three phase study analysing the implementation and impact of the nurse practitioner role in Australia (the Australian Nurse Practitioner Project or AUSPRAC) was undertaken in 2009, requiring nurse telephone interviewers to gather information about health outcomes directly from patients and their treating nurse practitioners. A team of several registered nurses was recruited and trained as telephone interviewers. The aim of this paper is to report on development and evaluation of the training process for telephone interviewers. Methods The training process involved planning the content and methods to be used in the training session; delivering the session; testing skills and understanding of interviewers post-training; collecting and analysing data to determine the degree to which the training process was successful in meeting objectives and post-training follow-up. All aspects of the training process were informed by established educational principles. Results Interrater reliability between interviewers was high for well-validated sections of the survey instrument resulting in 100% agreement between interviewers. Other sections with unvalidated questions showed lower agreement (between 75% and 90%). Overall the agreement between interviewers was 92%. Each interviewer was also measured against a specifically developed master script or gold standard and for this each interviewer achieved a percentage of correct answers of 94.7% or better. This equated to a Kappa value of 0.92 or better. Conclusion The telephone interviewer training process was very effective and achieved high interrater reliability. We argue that the high reliability was due to the use of well validated instruments and the carefully planned programme based on established educational principles. There is limited published literature on how to successfully operationalise educational principles and tailor them for specific research studies; this report addresses this knowledge gap.

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Aim This paper reports on the development and evaluation of an integrated clinical learning model to inform ongoing education for surgical nurses. The research aim was to evaluate the effectiveness of implementing a Respiratory Skills Update (ReSKU) education program, in the context of organisational utility, on improving surgical nurses' practice in the area of respiratory assessment. Background Continuous development and integration of technological innovations and research in the healthcare environment mandate the need for continuing education for nurses. Despite an increased worldwide emphasis on this, there is scant empirical evidence of program effectiveness. Methods A quasi experimental pre test, post test non–equivalent control group design evaluated the impact of the ReSKU program on surgical nurses' clinical practice. The 2008 study was conducted in a 400 bed regional referral public hospital and was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies. Findings The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group's reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales. Conclusion The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

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This study investigated the relationships between knowledge and efficacy for teaching sustainability in a sample of 266 pre-service primary teachers at a large, metropolitan university in Australia. A survey gathered information about the participant’s attitudes and self-efficacy for education for sustainability, along with their perceived and actual knowledge of environmental sustainability issues. The participants typically believed they were confident in their abilities to engage with education for sustainability with self-efficacy increasing with increased levels of perceived knowledge. However no relationship was found between perceived knowledge and actual knowledge which suggests that the participants either do not feel constrained by their lack of knowledge, or are perhaps unaware of their actual knowledge of sustainability issues. This lack of relationship may have implications for the development of pedagogical content knowledge with pre-service teachers potentially developing shallow, tokenistic approaches to Education for Sustainability.

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Background Knowledge of current trends in nurse-administered procedural sedation and analgesia (PSA) in the cardiac catheterisation laboratory (CCL) may provide important insights into how to improve safety and effectiveness of this practice. Objective To characterise current practice as well as education and competency standards regarding nurse-administered PSA in Australian and New Zealand CCLs. Design A quantitative, cross-sectional, descriptive survey design was used. Methods Data were collected using a web-based questionnaire on practice, educational standards and protocols related to nurse-administered PSA. Descriptive statistics were used to analyse data. Results A sample of 62 nurses, each from a different CCL, completed a questionnaire that focused on PSA practice. Over half of the estimated total number of CCLs in Australia and New Zealand was represented. Nurse-administered PSA was used in 94% (n = 58) of respondents CCLs. All respondents indicated that benzodiazepines, opioids or a combination of both is used for PSA (n = 58). One respondent indicated that propofol was also used. 20% (n = 12) indicated that deep sedation is purposefully induced for defibrillation threshold testing and cardioversion without a second medical practitioner present. Sedation monitoring practices vary considerably between institutions. 31% (n = 18) indicated that comprehensive education about PSA is provided. 45% (n = 26) indicated that nurses who administer PSA should undergo competency assessment. Conclusion By characterising nurse-administered PSA in Australian and New Zealand CCLs, a baseline for future studies has been established. Areas of particular importance to improve include protocols for patient monitoring and comprehensive PSA education for CCL nurses in Australia and New Zealand.

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Aims and objectives To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses. Background Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present. Design A qualitative exploratory design was employed. Methods Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes. Results Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements. Conclusions The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory. Relevance to clinical practice Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential.

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Background: Side effects of the medications used for procedural sedation and analgesia in the cardiac catheterisation laboratory are known to cause impaired respiratory function. Impaired respiratory function poses considerable risk to patient safety as it can lead to inadequate oxygenation. Having knowledge about the conditions that predict impaired respiratory function prior to the procedure would enable nurses to identify at-risk patients and selectively implement intensive respiratory monitoring. This would reduce the possibility of inadequate oxygenation occurring. Aim: To identify pre-procedure risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory. Design: Retrospective matched case–control. Methods: 21 cases of impaired respiratory function were identified and matched to 113 controls from a consecutive cohort of patients over 18 years of age. Conditional logistic regression was used to identify risk factors for impaired respiratory function. Results: With each additional indicator of acute illness, case patients were nearly two times more likely than their controls to experience impaired respiratory function (OR 1.78; 95% CI 1.19–2.67; p = 0.005). Indicators of acute illness included emergency admission, being transferred from a critical care unit for the procedure or requiring respiratory or haemodynamic support in the lead up to the procedure. Conclusion: Several factors that predict the likelihood of impaired respiratory function were identified. The results from this study could be used to inform prospective studies investigating the effectiveness of interventions for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory.

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The cardiac catheterisation laboratory (CCL) is a specialised medical radiology facility where both chronic-stable and life-threatening cardiovascular illness is evaluated and treated. Although there are many potential sources of discomfort and distress associated with procedures performed in the CCL, a general anaesthetic is not usually required. For this reason, an anaesthetist is not routinely assigned to the CCL. Instead, to manage pain, discomfort and anxiety during the procedure, nurses administer a combination of sedative and analgesic medications according to direction from the cardiologist performing the procedure. This practice is referred to as nurse-administered procedural sedation and analgesia (PSA). While anecdotal evidence suggested that nurse-administered PSA was commonly used in the CCL, it was clear from the limited information available that current nurse-led PSA administration and monitoring practices varied and that there was contention around some aspects of practice including the type of medications that were suitable to be used and the depth of sedation that could be safely induced without an anaesthetist present. The overall aim of the program of research presented in this thesis was to establish an evidence base for nurse-led sedation practices in the CCL context. A sequential mixed methods design was used over three phases. The objective of the first phase was to appraise the existing evidence for nurse-administered PSA in the CCL. Two studies were conducted. The first study was an integrative review of empirical research studies and clinical practice guidelines focused on nurse-administered PSA in the CCL as well as in other similar procedural settings. This was the first review to systematically appraise the available evidence supporting the use of nurse-administered PSA in the CCL. A major finding was that, overall, nurse-administered PSA in the CCL was generally deemed to be safe. However, it was concluded from the analysis of the studies and the guidelines that were included in the review, that the management of sedation in the CCL was impacted by a variety of contextual factors including local hospital policy, workforce constraints and cardiologists’ preferences for the type of sedation used. The second study in the first phase was conducted to identify a sedation scale that could be used to monitor level of sedation during nurse-administered PSA in the CCL. It involved a structured literature review and psychometric analysis of scale properties. However, only one scale was found that was developed specifically for the CCL, which had not undergone psychometric testing. Several weaknesses were identified in its item structure. Other sedation scales that were identified were developed for the ICU. Although these scales have demonstrated validity and reliability in the ICU, weaknesses in their item structure precluded their use in the CCL. As findings indicated that no existing sedation scale should be applied to practice in the CCL, recommendations for the development and psychometric testing of a new sedation scale were developed. The objective of the second phase of the program of research was to explore current practice. Three studies were conducted in this phase using both quantitative and qualitative research methods. The first was a qualitative explorative study of nurses’ perceptions of the issues and challenges associated with nurse-administered PSA in the CCL. Major themes emerged from analysis of the qualitative data regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements. The second study in Phase Two was a cross-sectional survey of nurse-administered PSA practice in Australian and New Zealand CCLs. This was the first study to quantify the frequency that nurse-administered PSA was used in the CCL setting and to characterise associated nursing practices. It was found that nearly all CCLs utilise nurse-administered PSA (94%). Of note, by characterising nurse-administered PSA in Australian and New Zealand CCLs, several strategies to improve practice, such as setting up protocols for patient monitoring and establishing comprehensive PSA education for CCL nurses, were identified. The third study in Phase Two was a matched case-control study of risk factors for impaired respiratory function during nurse-administered PSA in the CCL setting. Patients with acute illness were found to be nearly twice as likely to experience impaired respiratory function during nurse-administered PSA (OR=1.78; 95%CI=1.19-2.67; p=0.005). These significant findings can now be used to inform prospective studies investigating the effectiveness of interventions for impaired respiratory function during nurse-administered PSA in the CCL. The objective of the third and final phase of the program of research was to develop recommendations for practice. To achieve this objective, a synthesis of findings from the previous phases of the program of research informed a modified Delphi study, which was conducted to develop a set of clinical practice guidelines for nurse-administered PSA in the CCL. The clinical practice guidelines that were developed set current best practice standards for pre-procedural patient assessment and risk screening practices as well as the intra and post-procedural patient monitoring practices that nurses who administer PSA in the CCL should undertake in order to deliver safe, evidence-based and consistent care to the many patients who undergo procedures in this setting. In summary, the mixed methods approach that was used clearly enabled the research objectives to be comprehensively addressed in an informed sequential manner, and, as a consequence, this thesis has generated a substantial amount of new knowledge to inform and support nurse-led sedation practice in the CCL context. However, a limitation of the research to note is that the comprehensive appraisal of the evidence conducted, combined with the guideline development process, highlighted that there were numerous deficiencies in the evidence base. As such, rather than being based on high-level evidence, many of the recommendations for practice were produced by consensus. For this reason, further research is required in order to ascertain which specific practices result in the most optimal patient and health service outcomes. Therefore, along with necessary guideline implementation and evaluation projects, post-doctoral research is planned to follow up on the research gaps identified, which are planned to form part of a continuing program of research in this field.

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Saudi Arabian education is undergoing substantial reform in the context of a nation transitioning from a resource-rich economy to a knowledge economy. Gifted students are important human resources for such developing countries. However, there are some concerns emanating from the international literature that gifted students have been neglected in many schools due to teachers’ attitudes toward them. The literature shows that future teachers also hold similar negative attitudes, especially those in Special Education courses who, as practicing teachers, are often responsible for supporting the gifted education process. The purpose of this study was to explore whether these attitudes are held by future special education teachers in Saudi Arabia, and how the standard gifted education course, delivered as part of their program, impacts on their attitudes toward gifted students. The study was strongly influenced by the Theory of Reasoned Action (Ajzen, 1980, 2012) and the Theory of Personal Knowledge (Polanyi, 1966), which both suggest that attitudes are related to people’s (i.e. teachers’) beliefs. A mixed methods design was used to collect quantitative and qualitative data from a cohort of students enrolled in a teacher education program at a Saudi Arabian university. The program was designed for students majoring in special education. The quantitative component of the study involved an investigation of a cohort of future special education teachers taking a semester-long course in gifted education. The data were primarily sourced from a standard questionnaire instrument modified in the Arabic language, and supplemented with questions that probed the future teachers’ attitudes toward gifted children. The participants, 90 special education future teachers, were enrolled in an introductory course about gifted education. The questionnaire contained 34 items from the "Opinions about the Gifted and Their Education" (Gagné, 1991) questionnaire, utilising a five-point Likert scale. The quantitative data were analysed through the use of descriptive statistics, Spearman correlation Coefficients, Paired Samples t-test, and Multiple Linear Regression. The qualitative component focussed on eight participants enrolled in the gifted education course. The primary source of the qualitative data was informed by individual semi-structured interviews with each of these participants. The findings, based on both the quantitative and qualitative data, indicated that the majority of future special education teachers held, overall, slightly positive attitudes toward gifted students and their education. However, the participants were resistant to offering special services for the gifted within the regular classroom, even when a comparison was made on equity grounds with disabled students. While the participants held ambivalent attitudes toward ability grouping, their attitudes were positive toward grade acceleration. Further, the majority agreed that gifted students are likely to be rejected by their teachers. Despite such judgments, they considered the gifted to be a valuable resource for Saudi society. Differences within the cohort were found when two variables emerged as potential predictors of attitude: age, experience, and participants’ hometown. The younger (under 25 years old) future special education teachers, with no internship or school practice experience, held more positive attitudes toward the gifted students, with respect to their general needs, than did the older participants with previous school experiences. Additionally, participants from a rural region were more resistant toward gifted education than future teachers from urban areas. The findings also indicated that the attitudes of most of the participants were significantly improved, as a result of the course, toward ability grouping such as special classes and schools, but remained highly concerned about differentiation within regular classrooms with either elitism or time pressure. From the findings, it can be confirmed that a lectured-based course can serve as a starting point from which to focus future teachers’ attention on the varied needs of the gifted, and as a conduit for learning about special services for the gifted. However, by itself, the course appears to have minimal influence on attitudes toward differentiation. As a consequence, there is merit in its redevelopment, and the incorporation of more practical opportunities for future teachers to experience the teaching of the gifted.

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Objective To determine changes in ability to identify specific vegetables and fruits, and attitudes towards vegetables and fruit, associated with the introduction of a school-based food garden. Design A 12-month intervention trial using a historical control (control n 132, intervention n 120), class-based, self-administered questionnaires requiring one-word answers and 3-point Likert scale responses. Setting A state primary school (grades 4 to 7) in a low socio-economic area of Brisbane, Australia. Intervention The introduction of a school-based food garden, including the funding of a teacher coordinator for 11 h/week to facilitate integration of garden activities into the curriculum. Main outcome measures Ability to identify a series of vegetables and fruits, attitudes towards vegetables and fruit. Analysis Frequency distributions for each item were generated and χ2 analyses were used to determine statistical significance. Exploratory factor analysis was employed to detect major trends in data. Results The intervention led to enhanced ability to identify individual vegetables and fruits, greater attention to origins of produce (garden-grown and fresh), changes to perceived consumption of vegetables and fruits, and enhanced confidence in preparing fruit and vegetable snacks, but decreased interest in trying new fruits. Conclusions The introduction of this school-based food garden was associated with skill and attitudinal changes conducive to enhancing vegetable and fruit consumption. The ways in which such changes might impact on dietary behaviours and intake require further analysis.