Runoff, soil loss, and nutrient transport from cropping systems on Red Ferrosols in tropical northern Australia.

Runoff, soil loss, and nutrient loss were assessed on a Red Ferrosol in tropical Australia over 3 years. The experiment was conducted using bounded, 100-m(2) field plots cropped to peanuts, maize, or grass. A bare plot, without cover or crop, was also instigated as an extreme treatment. Results showed the importance of cover in reducing runoff, soil loss, and nutrient loss from these soils. Runoff ranged from 13% of incident rainfall for the conventional cultivation to 29% under bare conditions during the highest rainfall year, and was well correlated with event rainfall and rainfall energy. Soil loss ranged from 30 t/ha. year under bare conditions to <6 t/ha. year under cropping. Nutrient losses of 35 kg N and 35 kg P/ha. year under bare conditions and 17 kg N and 11 kg P/ha. year under cropping were measured. Soil carbon analyses showed a relationship with treatment runoff, suggesting that soil properties influenced the rainfall runoff response. The cropping systems model PERFECT was calibrated using runoff, soil loss, and soil water data. Runoff and soil loss showed good agreement with observed data in the calibration, and soil water and yield had reasonable agreement. Longterm runs using historical weather data showed the episodic nature of runoff and soil loss events in this region and emphasise the need to manage land using protective measures such as conservation cropping practices. Farmers involved in related, action-learning activities wished to incorporate conservation cropping findings into their systems but also needed clear production benefits to hasten practice change.

Producer Demonstration Sites (PDS) coordination and delivery

Producer Demonstration Site (PDS) - Funding to accommodate the establishment of 14 PDS sites over 3 years. Implementation of PDS to increase research adoption and practice change in Queensland.

Caring for our Country: Burnett Mary Paddock Monitoring Program

Estimating the environment impacts of land management practice change on the Great Barrier Reef water quality.

Water-use efficiency and productivity trends in Australian irrigated cotton: a review

The aim of this review is to report changes in irrigated cotton water use from research projects and on-farm practice-change programs in Australia, in relation to both plant-based and irrigation engineering disciplines. At least 80% of the Australian cotton-growing area is irrigated using gravity surface-irrigation systems. This review found that, over 23 years, cotton crops utilise 6-7ML/ha of irrigation water, depending on the amount of seasonal rain received. The seasonal evapotranspiration of surface-irrigated crops averaged 729mm over this period. Over the past decade, water-use productivity by Australian cotton growers has improved by 40%. This has been achieved by both yield increases and more efficient water-management systems. The whole-farm irrigation efficiency index improved from 57% to 70%, and the crop water use index is >3kg/mm.ha, high by international standards. Yield increases over the last decade can be attributed to plant-breeding advances, the adoption of genetically modified varieties, and improved crop management. Also, there has been increased use of irrigation scheduling tools and furrow-irrigation system optimisation evaluations. This has reduced in-field deep-drainage losses. The largest loss component of the farm water balance on cotton farms is evaporation from on-farm water storages. Some farmers are changing to alternative systems such as centre pivots and lateral-move machines, and increasing numbers of these alternatives are expected. These systems can achieve considerable labour and water savings, but have significantly higher energy costs associated with water pumping and machine operation. The optimisation of interactions between water, soils, labour, carbon emissions and energy efficiency requires more research and on-farm evaluations. Standardisation of water-use efficiency measures and improved water measurement techniques for surface irrigation are important research outcomes to enable valid irrigation benchmarks to be established and compared. Water-use performance is highly variable between cotton farmers and farming fields and across regions. Therefore, site-specific measurement is important. The range in the presented datasets indicates potential for further improvement in water-use efficiency and productivity on Australian cotton farms.

Evaluating the role of extension in helping to improve water quality in the Great Barrier Reef

From 2012-2014 the Queensland Government delivered an extension project to help sugarcane growers adopt best management practices to reduce pollutant loss to the Great Barrier Reef. Coutts J&R were engaged to measure progress towards the project's engagement, capacity gain and practice change targets. The monitoring and evaluation program comprised a database, post-workshop evaluations and grower and advisor surveys. Coutts J&R conducted an independent phone survey with 97 growers, a subset of the 900 growers engaged in extension activities. Of those surveyed 64% stated they had made practice changes. There was higher (74%) adoption by growers engaged in one-on-one extension than those growers only involved in group-based activities (36%). Overall, the project reported 41% (+/-10%, 95% confidence) of growers engaged made a practice change. The structured monitoring and evaluation program, including independent surveys, was essential to quantify practice change and demonstrate the effectiveness of extension in contributing to water quality improvement.

Leadership, fairness and gender: a practitioner's perspective

This Portfolio of Exploration outlines the course of learning by a practitioner on a personal leadership journey. It constructs a functional examination of ideas around leadership. It explores the belief system which underpins leadership practice and it also explores to what extent the increased participation of women can lead to a qualitatively different type of leadership. Different models of leadership are explored to find the model which can best fit with the author’s perception of leadership. The Women’s Intercultural Leadership Model is discussed. This model conceptualises leadership as the envisioning of oneself and others as potential leaders. It seeks to promote that recognition whilst at the same time encouraging personal transformation. The promotion of a values based leadership is examined. The value of fairness is examined as an element of functional leadership. The extent to which increasing the number of women in leadership can lead to a qualitatively different type of leadership is explored. Drucker’s assertion that every practice rests on theory is used to unearth the underlying assumptions of this reflective practitioner doctorate. Kegan’s Theory of Adult Mental Development and Subject-Object separation is used to explicitly examine knowledge construction. Myers Briggs Type Indicator (MBTI) and Assumption/Commitment/Behaviour/Outcome (ACBO) template are used to promote practice change.

L’agence en oncologie de l’Ontario : actifs organisationnels et professionnels à l’amélioration des soins et des services

Cette thèse s’intéresse à l’amélioration des soins et des services de santé et touche aux relations entre 3 grands thèmes de l’analyse des organisations de santé : la gouvernance, le changement et les pratiques professionnelles. En nous appuyant sur l’analyse organisationnelle contemporaine, nous visons à mieux comprendre l’interface entre l’organisation et les pratiques cliniques. D’une part, nous souhaitons mieux comprendre comment l’organisation structure et potentialise les pratiques des acteurs. D’autre part, dans une perspective d’acteurs stratégiques, nous souhaitons mieux comprendre le rôle des pratiques des professionnels dans l’actualisation de leur profession et dans la transformation et l’évolution des organisations. Notre étude se fonde sur l’hypothèse qu’une synergie accrue entre l’organisation et les pratiques des professionnels favorisent l’amélioration de la qualité des soins et des services de santé. En 2004, le gouvernement ontarien entreprend une importante réforme des soins et services dans le domaine du cancer et revoit les rôles et mandats du Cancer Care Ontario, l’organisation responsable du développement des orientations stratégiques et du financement des services en cancer dans la province. Cette réforme appelle de nombreux changements organisationnels et cliniques et vise à améliorer la qualité des soins et des services dans le domaine de l’oncologie. C’est dans le cadre de cette réforme que nous avons analysé l’implantation d’un système de soins et de services pour améliorer la performance et la qualité et analysé le rôle des pratiques professionnelles, spécifiquement les pratiques infirmières, dans la transformation de ce système. La stratégie de recherche utilisée correspond à l’étude approfondie d’un cas correspondant à l’agence de soins et de services en oncologie en Ontario, le Cancer Care Ontario, et des pratiques professionnelles infirmières évoluant dans ce modèle. Le choix délibéré de ce cas repose sur les modalités organisationnelles spécifiques à l’Ontario en termes de soins en oncologie. La collecte de données repose sur 3 sources principales : les entrevues semi-structurées (n=25), l’analyse d’une abondante documentation et les observations non participatives. La thèse s’articule autour de trois articles. Le premier article vise à définir le concept de gouvernance clinique. Nous présentons l’origine du concept et définissons ses principales composantes. Concept aux frontières floues, la gouvernance clinique est axée sur le développement d’initiatives cliniques et organisationnelles visant à améliorer la qualité des soins de santé et la sécurité des patients. L’analyse de la littérature scientifique démontre la prédominance d’une vision statique de la gouvernance clinique et d’un contrôle accentué des pratiques professionnelles dans l’atteinte de l’efficience et de l’excellence dans les soins et les services. Notre article offre une conception plus dynamique de la gouvernance clinique qui tient compte de la synergie entre le contexte organisationnel et les pratiques des professionnels et soulève les enjeux reliés à son implantation. Le second article s’intéresse à l’ensemble des leviers mobilisés pour institutionnaliser les principes d’amélioration continue de la qualité dans les systèmes de santé. Nous avons analysé le rôle et la portée des leviers dans l’évolution du système de soins en oncologie en Ontario et dans la transformation des pratiques cliniques. Nos données empiriques révèlent 3 phases et de nombreuses étapes dans la transformation du système. Les acteurs en position d’autorité ont mobilisé un ensemble de leviers pour introduire des changements. Notre étude révèle que la transformation du Cancer Care Ontario est le reflet d’un changement radical de type évolutif où chacune des phases est une période charnière dans la transformation du système et l’implantation d’initiatives de qualité. Le troisième article pose un regard sur un levier spécifique de transformation, celui de la communauté de pratique, afin de mieux comprendre le rôle joué par les pratiques professionnelles dans la transformation de l’organisation des soins et ultimement dans le positionnement stratégique de la profession infirmière. Nous avons analysé les pratiques infirmières au sein de la communauté de pratique (CDP) des infirmières en pratique avancée en oncologie. En nous appuyant sur la théorie de la stratégie en tant que pratique sociale, nos résultats indiquent que l’investissement de la profession dans des domaines stratégiques augmente les capacités des infirmières à transformer leurs pratiques et à transformer l’organisation. Nos résultats soulignent le rôle déterminant du contexte dans le développement de capacités stratégiques chez les professionnels. Enfin, nos résultats révèlent 3 stratégies émergentes des pratiques des infirmières : une stratégie de développement de la pratique infirmière en oncologie, une stratégie d’institutionnalisation des politiques de la CDP dans le système en oncologie et une stratégie de positionnement de la profession infirmière. Les résultats de notre étude démontrent que l’amélioration de la qualité des soins et des services de santé est située. L’implantation de transformations dans l’ensemble d’un système, tel que celui du cancer en Ontario, est tributaire d’une part, des capacités d’action des acteurs en position d’autorité qui mobilisent un ensemble de leviers pour introduire des changements et d’autre part, de la capacité des acteurs à la base de l’organisation à s’approprier les leviers pour développer un projet professionnel, améliorer leurs pratiques professionnelles et transformer le système de soins.

Leadership dans le contexte de transformation des organisations de santé de première ligne au Québec : étude de la création et de l'implantation des groupes de médecine de famille(GMF)

Contexte: Alors que de nouvelles organisations de services de première ligne, les groupes de médecine de famille (GMF) ont été implantés au Québec au début des années 2000 afin d’améliorer l’accessibilité et l’intégration des soins, nous avons que peu de recul sur la façon dont les acteurs impliqués dans le changement ont exercé leur leadership pour influencer l’implantation des GMF. Objectifs: La présente étude a pour but de mettre en évidence les rôles et actions des acteurs clés impliqués dans l’implantation des GMF et ceci pour l’ensemble du processus de transformation (de l’idée de création jusqu’à l’implantation opérationnelle des nouvelles activités), tant en les reliant aux capacités des acteurs ainsi qu’aux facteurs (organisationnels, règlementaires et culturels) aidant ou entravant le leadership dans le contexte de changement. Méthodologie: Il s’agit d’une étude de cas multiples, reposant sur trois cas (GMF) qui disposent de caractéristiques organisationnelles différentes (taille, statut, situation géographique). Des entrevues semi-dirigées ont été réalisées avec les professionnels de chaque GMF (médecins, infirmières et gestionnaires). En outre, de la documentation sur le fonctionnement et l’organisation des GMF a été consultée afin de diversifier les sources de données. Résultats: On remarque une évolution du leadership tout au long du processus de changement. Le rôle du médecin responsable a été crucial lorsqu’il s’agit de communiquer le besoin de changer de pratique et la nouvelle vision de la pratique, ou encore afin de définir le rôle et les responsabilités de chacun des membres des GMF au moment de la création de ceux-ci. Un leadership plus collectif et partagé s’est manifesté au moment de l’opérationnalisation de l’implantation, par des interactions d’influence de l’ensemble des acteurs internes mais aussi externes aux GMF (CSSS, ASSS, DRMG). Conclusion: Le cadre conceptuel proposé a permis d’identifier l’évolution du leadership tout au long du processus de changement organisationnel. Il a également permis de relier les rôles et actions des acteurs aux capacités et aux facteurs aidant ce leadership.

Les facilitateurs et les solutions à la pratique optimale des médecins dans le traitement de l’asthme

OBJECTIF : Déterminer les principales solutions qui facilitent la pratique optimale des médecins dans le traitement de l’asthme, incluant la prescription d’un médicament de contrôle à long terme et l’utilisation de plans d’action écrits. MÉTHODOLOGIE: Des entrevues individuelles semi-structurées ont été menées avec des médecins de différentes spécialités (médecins de famille, pédiatres, urgentologues, pneumologues et allergologues). Ces entrevues ont été transcrites puis analysées qualitativement de manière indépendante par deux chercheures qualifiées. RÉSULTATS : Quarante-deux médecins ont été interviewés. Un total de 867 facilitateurs et solutions ont été exprimés, répondant à trois de leurs besoins: (1) avoir du soutien dans la prestation de soins optimaux, (2) être habileté à aider et motiver les patients à suivre leurs recommandations et (3) avoir l’opportunité d’offrir des services efficients. À partir de ces données, une taxonomie de facilitateurs et de solutions comprenant dix catégories a également été développée. CONCLUSION : Les médecins ont proposé une multitude de facilitateurs et de solutions pour soutenir la pratique optimale. Ils varient essentiellement selon la spécialité et le comportement visé (prescription de médicaments de contrôle à long terme, utilisation de plans d’autogestion écrits et la gestion générale de l’asthme). Cela fait ressortir l’importance d’effectuer le choix des interventions en étroite collaboration avec les utilisateurs de connaissances afin d’obtenir des solutions qui soient perçues comme faisables et applicables, ayant ainsi potentiellement plus de chances de mener à un changement de pratique. La nouvelle taxonomie offre la possibilité d’utiliser un langage commun pour classifier les facilitateurs et les solutions.

Medical error and decision making : learning from the past and present in intensive care

Background : Human error occurs in every occupation. Medical errors may result in a near miss or an actual injury to a patient that has nothing to do with the underlying medical condition. Intensive care has one of the highest incidences of medical error and patient injury in any specialty medical area; thought to be related to the rapidly changing patient status and complex diagnoses and treatments.

Purpose : The aims of this paper are to: (1) outline the definition, classifications and aetiology of medical error; (2) summarise key findings from the literature with a specific focus on errors arising from intensive care areas; and (3) conclude with an outline of approaches for analysing clinical information to determine adverse events and inform practice change in intensive care.

Data source : Database searches of articles and textbooks using keywords: medical error, patient safety, decision making and intensive care. Sociology and psychology literature cited therein.

Findings : Critically ill patients require numerous medications, multiple infusions and procedures. Although medical errors are often detected by clinicians at the bedside, organisational processes and systems may contribute to the problem. A systems approach is thought to provide greater insight into the contributory factors and potential solutions to avoid preventable adverse events.

Conclusion : It is recommended that a variety of clinical information and research techniques are used as a priority to prevent hospital acquired injuries and address patient safety concerns in intensive care.

Staff-focused interventions to increase referrals for depression in aged care facilities: a cluster randomized controlled trial

Objective: 

Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks

BACKGROUND: Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. OBJECTIVES: Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. METHODS: A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. RESULTS: Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. CONCLUSION: Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.

Ensino por investigação: contribuições de um curso de formação continuada para a prática de professores de ciências naturais e biologia

Normally initial teacher training has not been sufficient to provide all the tools for an updated and efficient teaching practice. It is presented here one of the ways of working the completion of the initial training through a course of continuing education. This course is based on inquiry teaching which is considered an important teaching strategy for science education. This kind of teaching enables improvement of students reasoning and cognitive skills, the cooperation among them, the understanding of the nature of scientific work, and the motivation to think about the relationship between science, technology, society and environment. For this dissertation a course of continuing education based on this approach was followed in order to evaluate which contributions it can bring to the teaching practice. The course was followed based on three stages: on the first there was a questionnaire and an informal interview; next it happened through participant observation with audio and visual aid; the third stage happened through semi structured interview. The collected information was analyzed based on Content Analysis. An inquiry teaching pedagogical material was produced for the course including some examples and applications of this approach. The aim of the material is that it can be a support for the teachers after de course. The results allowed seeing that the course was very useful, different from the traditional and the teachers that put the approach to use found it to be very positive. Thus it can be said that some of the teachers who participated will try again to apply it, try to contextualize more the teaching situations with the students day to day life, as well make them more active and critic. We can also gather from the study, that the inquiry teaching is a very different tool from what the teacher was taught and is accustomed to use and the theoretical comprehension, acceptance and practice change is a complicated process and demands time

Asthma management : implementation of short-acting beta agonist guidelines in Western Australia:a unique collaboration

Background: The Respiratory Health Network in Western Australia developed the Asthma Model of Care in 2010 which incorporates best practice guidelines. At the same time short-acting beta agonist guidelines (SABA) were developed by stakeholder consensus at University of Western Australia (UWA) and incorporated the use of an Asthma Action Plan Card. Objective: To report on the implementation of a key component of the WA Asthma Model of Care, the SABA guidelines that incorporate the Asthma Action Plan card. Methods: Implementation strategies included lectures, direct pharmacy detailing, media releases, and information packs (postal and electronic). Groups targeted included pharmacists, consumers and medical practitioners. Results: State-based (n=18) and national (n=6) professional organisations were informed about the launch of the guidelines into practice in WA. In the four-month implementation period more than 47,000 Asthma Action Plan Cards were distributed, primarily to community pharmacies. More than 500 pharmacies were provided with information packs or individual detailing. More than 10,000 consumers were provided with information about the guidelines. Conclusions and implications: The collaboration of stakeholders in this project allowed for widespread access to various portals which, in turn, resulted in a multifaceted approach in disseminating information. Ongoing maintenance programs are required to sustain and build on the momentum of the implementation program and to ultimately address patient outcomes and practice change, which would be the longer-term goals of such a project. Future research will seek to ascertain the impact of the card on patient outcomes in WA.

CAUTI prevention bundles: improving best practices within Western Health for continued success

Background: Persons in acute care settings who have indwelling urethral catheters are at higher risk of acquiring a urinary tract infection (UTI). Other complications related to prolonged indwelling urinary catheters include decreased mobility, damage to the meatus and/or urethra, increase use of antibiotics, increased length of stay, and pain. UTIs in acute care settings account for 30 to 40% of all health care associated infections (HAIs). Of these, 80% are catheter associated UTIs (CAUTIs). Purpose: To utilized the CDC (2009) bundle approach for CAUTI prevention and create a program which supports a multimodal method to improving urinary catheter use, maintenance, and removal, including a continuing competency program where role expansion is anticipated. Methods: A comprehensive review of the literature was conducted. Physicians were consulted through a power point presentation followed by a letter explaining the project, a questionnaire, and two selections of relevant literature. Nursing staff and allied health professionals from the target units of 3A and 3B medicine attended one of two lunch and learns. They were presented the project via a power point presentation and the same questionnaire as distributed to physicians. Results: Five e-learning modules, a revised policy, and clinical pathway have been developed to support staff with best practice knowledge transfer. Conclusion: Behaviour changes need to be approached with a framework, extensive consultation, and education. Sustainability of any practice change cannot occur without having completed the background work to ensure staff have access to tools to support the change.