Improving child and family outcomes following complicated births requiring admission to neonatal intensive care units

This paper reviews current research regarding the impact of birth complications, such as preterm labour, on parents and the nuclear family system. Specifically, how parents cope with the neonatal intensive care unit (NICU) experience and the associated decision-making tasks required during complicated births will be investigated. Consequences of poor adaptation to prematurity for the parent, family and infant relationships will also be discussed. The importance of informed decision-making, perceived control, self-esteem and the benefits of certain strategies, such as kangaroo care (skin-to-skin contact), in the facilitation of greater levels of attachment and improved relationships, will be highlighted. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

Hope promoting strategies of registered nurses

Aim. This paper describes self-reported hope-promoting strategies used by Registered Nurses whilst providing care for older patients in acute and long-term care settings.
Background. The literature is replete with claims that Registered Nurses engage in hope facilitation with their patients. However, these claims are largely conjecture, with few studies empirically identifying the extent to which Registered Nurses use hope interventions with their patients. Further, some authors have questioned whether nurses have the necessary skills to undertake this vital aspect of care.
Methods. In this Gadamerian hermeneutic phenomenological study, undertaken in 2003 in Australia, we used in-depth audiotaped interviews to collect data with 14 Registered Nurses. The interviews were transcribed verbatim and analysed using the Turner method.
Findings. Whilst participants clearly reported that they engaged in hope facilitation with older patients, there were differences between the reported strategies used by Registered Nurses in acute and long-term care settings. Further, the strategies reported were not unique to hope promotion and have been variously described in the literature on caring, presencing, holistic nursing and therapeutic nursing.
Conclusion. It is clear that participants considered hope promotion to be a vital aspect of their care. However, the strategies that they reported were limited and not inclusive of many and varied suggestions emerging from published studies on hope promotion. Therefore, we recommend that nursing curricula, professional development and in-service education programmes place hope facilitation on their agenda and foster a culture in which promoting hope is seen as a vital aspect of nursing care.

Parental decision-making surrounding complicated births: the impact on parent-infant and infant-marital relationships

This paper reviews current research regarding the impact of birth complications on parental decisionmaking, and the resulting effects on parent-infant and infant-marital relationships. It discusses the importance of informed decision-making on parental satisfaction of the birthing experience, and the benefits of certain strategies, such as kangaroo care, in the facilitation of greater levels of attachment and improved relationships. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

Knowledge management and its links with quality

Knowledge management is a concept that continues to draw a lot of interest. It is the process of sharing knowledge within an organisation to achieve better performance. It can be utilised by all organisations, many of which may not even be aware they are using the concept nor of its links with Quality management. By implementing an effective KM system increased organisational performance and ultimately a competitive advantage can be obtained - both of which correlate to the philosophy of Quality. This paper raises issues about the relationship between the gathering, storing and sharing of knowledge and the philosophy of continuous improvement with the facilitation of teamwork. It concludes by attempting to encourage further debate and research into the area by suggesting that Knowledge Management may be well the 'catalyst' for the resurgence of Quality Management.

Service failure and recovery in the presence of service guarantees

This paper presents a conceptual model and propositions outlining how, in a service recovery encounter, service guarantees (unconditional and specific) operate in conjunction with other organisational recovery variables (guarantee facilitation and service provider concern), to influence customers’ justice perceptions and subsequent satisfaction evaluations.

Exploring the relationship between customer loyalty to the service worker and customer citizenship behaviors to the service organization

This paper conceptualizes the positive relationship between customer loyalty to the service worker (personal loyalty) and customer citizenship behaviors to the service organization including: positive word of mouth; suggestions for improvements; customer participation in activities; benevolent acts of service facilitation; customer policing; customer flexibility; customer voice and displays of relationship affiliation.

Qualitive research in a cross-cultural context: Fijian experiences

In this article, the authors discuss the experiences of conducting qualitative research in traditional Fijian communities. This provided the setting for the cross-cultural exchange between the researcher and research participants and from which the authors draw important considerations for the design of future qualitative studies. In particular, the authors discuss the need to adapt essentially Western research designs to accommodate different cross-cultural styles of facilitation, group dynamics, spatial arrangements, gender issues, protocol, patterns of participation, and perception of time. They propose a model that clarifies the types of roles and styles of facilitation observed in a Fijian workshop setting and comment on how different cross-cultural dynamics between the researcher and participants can influence the success of qualitative research.

What makes continuing education effective : perspectives of community pharmacists

Objective To explore how different aspects of the professional environment for Australian community pharmacists are perceived to be influencing the effectiveness of continuing education models in improving practice.

Setting Australian community pharmacy.

Methods A convenience sample of practising community pharmacists (n = 15) was recruited using the 'snowballing' technique to participate in one of four focus group teleconferences. Each focus group examined continuing education experiences from different professional perspectives and training needs (recent graduates, experienced practitioners, specialist practitioners and rural/remote practitioners).

Key findings Facilitation of professional development by accreditation bodies, and new challenges resulting from the introduction of cognitive services were seen to promote a favourable environment for continuing education engagement. Complex continuing education delivery models combined with high costs and excessive workloads made it more difficult to engage with continuing education systems or try to apply knowledge to the workplace.

Conclusion Results support findings from previous research that practice development requires a multifaceted approach with continuing education as just one component. Affordable and integrated models of continuing education are required in order to optimise efficacy for participants.

Consumer participation in acute care settings : an Australian experience

Consumer partnerships have been embraced as an important component of building high quality health care services. While nurses have the greatest contact with clients in hospital, little is known of their views about consumer participation or how they facilitate that participation at the bedside. Using focus group interviews and participant observation methods, this project explored nurses' approaches to working with consumers to support their participation in health care delivery. Findings indicate a sharp contrast between the ideas that nurses expressed and the actions observed in practice. It was clear from the interviews that nurses had adopted the rhetoric surrounding consumer participation, yet observational data revealed nursing practices that excluded active participation by consumers. Factors influencing nurses' facilitation of consumer participation were identified as the division of nursing labour in the setting, limited communication between nurses and patients and environmental constraints.

Teaching presence in computer conferencing : lessons from the United States and Australia

This paper uses the category of teaching presence as a framework to analyze and compare teaching presence in two computer conference contexts. Teaching presence is defined as the design, facilitation, and direction of cognitive and social processes. This paper is based on an interview designed to capture reflections about teaching practices of two instructors, one from the United States and the other from Australia. We first present individual case studies of the two computer conference contexts, followed by conclusions and implications for research and practice.

Customer citizenship behaviours : towards the development of a typology

Eight types of customer citizenship behaviours were extracted from the existing marketing literature, and the more developed organisational citizenship behaviour literature. These included: positive word of mouth behaviour; suggestions for service improvements; participation in organisation events/activities; benevolent acts of service facilitation; policing of other customers; flexibility; voice and displays of relationship affiliation. Although citizenship behaviours such as positive word-ofmouth and voice have established empirical measures, the other types of customer citizenship behaviours do not. The objective of this study, therefore, was to source, adapt and derive measures for each of the eight identified citizenship behaviours. Using exploratory and confirmatory factor analysis, these measures were validated across three service contexts.

The life and times of an online discussion

Teaching online and facilitating effective discussion with students requires adapting existing patterns of traditional classroom discussion techniques. This paper examines the life and times of a number of online discussions in both graduate and undergraduate papers for eduction students at the University of Waikato. Key features examined include the creation of an effective online environment model, the level and type of participation, along with modes of effective discussion assessment. The impact and development of the conversational style software environment that includes pictures of the participants has proved to be a critical aspect of discussion development and innovation.

223

"There are those films that are formalistic by design – the materialist films, which can’t be accused of doing injustice to their subject matter. Most notable in this area has been Dirk de Bruyn’s "Direct on Film" series. The resulting films (Vision, 223, among others) comprise of frantic flashes of colour and shape – very annoying to the viewer. But once the filmmaker (or someone) explains that the films are visual music, it’s surprising how watchable they become! This example points to the importance of the viewer in the experimental film scenario. Whilst the modes of viewing for particular types of films take time to learn, a certain facilitation of them is possible if the viewer is open and adaptable." http://www.innersense.com.au/mif/debruyn_films.html

"With 223 I used Photographs from my past as a base. It gives the eyes something to come back to from the faster abstract shapes. The Pos/Neg flickering gives a feeling of depth. Its called 223 because I had some letterset of the numbers 223. There is a layering of images and techniques."

Ethical dilemmas of a large national multi-centre study in Australia

Aims and objectives: To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study.

Background: Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects.

Methods: The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC.

Results: Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study.

Conclusions: Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services.

Relevance to clinical practice: The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.

Integrating farm production and natural resource management in Tasmania, Australia

This paper reports on the social learning from a project aimed to increase the knowledge and capacity of a group of farmers in Tasmania, Australia, to reduce the impacts of intensive agriculture on soil health and waterways, and to optimise the efficient use of on-farm inputs. The plan-do-check-review cycle adopted in this project required the farmers to assess current management practices, identify where to make changes, implement changes and monitor for improvements. The success of the project was due to careful attention to social processes as well as technical input. The combination of group activities with individual mentoring and one-to-one advice was key to the success of this project in enabling farmers to undertake on-farm action.

There is value in social learning that included developing relationships, using one-to-one contact and group workshops together with expert input when working with farmers to tackle some difficult and complex interrelated natural resource management and production issues. Sufficient time must be allowed for the process of facilitating good practice in natural resource management, particularly when addressing systemic environmental impacts. Practical operational recommendations are presented on communication, feedback, focus of activities and meeting content, as these will be useful to other project officers and facilitators working with farmer groups.