The impact of a model of nurse education to improve knowledge and recognition of delirium in older persons by registered nurses

Introduction: Delirium is a serious issue associated with high morbidity and mortality in older hospitalised people. Early recognition enables diagnosis and treatment of underlying cause/s, which can lead to improved patient outcomes. However, research shows knowledge and accurate nurse recognition of delirium and is poor and lack of education appears to be a key issue related to this problem. Thus, the purpose of this randomised controlled trial (RCT) was to evaluate, in a sample of registered nurses, the usability and effectiveness of a web-based learning site, designed using constructivist learning principles, to improve acute care nurse knowledge and recognition of delirium. Prior to undertaking the RCT preliminary phases involving; validation of vignettes, video-taping five of the validated vignettes, website development and pilot testing were completed. Methods: The cluster RCT involved consenting registered nurse participants (N = 175) from twelve clinical areas within three acute health care facilities in Queensland, Australia. Data were collected through a variety of measures and instruments. Primary outcomes were improved ability of nurses to recognise delirium using written validated vignettes and improved knowledge of delirium using a delirium knowledge questionnaire. The secondary outcomes were aimed at determining nurse satisfaction and usability of the website. Primary outcome measures were taken at baseline (T1), directly after the intervention (T2) and two months later (T3). The secondary outcomes were measured at T2 by participants in the intervention group. Following baseline data collection remaining participants were assigned to either the intervention (n=75) or control (n=72) group. Participants in the intervention group were given access to the learning intervention while the control group continued to work in their clinical area and at that time, did not receive access to the learning intervention. Data from the primary outcome measures were examined in mixed model analyses. Results: Overall, the effect of the online learning intervention over time comparing the intervention group and the control group were positive. The intervention groups‘ scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for delirium recognition when comparing T2 and T1 results (t=2.58 p=0.012) between the control and intervention group but not for changes in delirium recognition scores between the two groups from T3 and T1 (t=1.80 p=0.074). The majority of the participants rated the website highly on the visual, functional and content elements. Additionally, nearly 80% of the participants liked the overall website features and there were self-reported improvements in delirium knowledge and recognition by the registered nurses in the intervention group. Discussion: Findings from this study support the concept that online learning is an effective and satisfying method of information delivery. Embedded within a constructivist learning environment the site produced a high level of satisfaction and usability for the registered nurse end-users. Additionally, the results showed that the website significantly improved delirium knowledge & recognition scores and the improvement in delirium knowledge was retained at a two month follow-up. Given the strong effect of the intervention the online delirium intervention should be utilised as a way of providing information to registered nurses. It is envisaged that this knowledge would lead to improved recognition of delirium as well as improvement in patient outcomes however; translation of this knowledge attainment into clinical practice was outside the scope of this study. A critical next step is demonstrating the effect of the intervention in changing clinical behaviour, and improving patient health outcomes.

Negotiating : experiences of community nurses when contracting with clients

A community nurse is required to have excellent interpersonal, teaching, collaborative and clinical skills in order to develop effective individualised client care contracts. Using a descriptive qualitative design data was collected from two focus groups of fourteen community nurses to explore the issues surrounding negotiating and contracting client care contracts from the perspective of community nurses. Thematic analysis revealed three themes: ‘assessment of needs’, ‘education towards enablement’, and ‘negotiation’. ‘Assessment of needs’ identified that community nurses assess both the client’s requirements for health care as well as the ability of the nurse to provide that care. ‘Education towards enablement’ described that education of the client is a common strategy used by community nurses to establish realistic goals of health care as part of developing an ongoing care plan. The final theme, ‘negotiation’, involved an informed agreement between the client and the community nurse which forms the origin of the care contract that will direct the partnership between the client and the nurse. Of importance for community nurses is that development of successful person-centred care contracts requires skillful negotiation of care that strikes the balance between the needs of the client and the ability of the nurse to meet those needs.

Narrative : family trauma or challenge and resilience in the Galapagos Archipelago

The chapter is a "here and now" narration in the first person as witnessed and experienced by the author during field work in the Galapagos Islands in 1976-79. The story begins on the most remote volcanic island of Fernandina where the breeding biology of Flightless cormorants was being studied. A small selection of the many potentially life threatening situations and challenges is described including stories related to the birth of their son.

A phenomenological study of dream interpretation among the Xhosa-speaking people in rural South Africa

Psychologists investigating dreams in non-Western cultures have generally not considered the meanings of dreams within the unique meaning-structure of the person in his or her societal context. The study was concerned with explicating the indigenous system of dream interpretation of the Xhosa-speaking people, as revealed by acknowledged dream experts, and elaborating upon the life-world of the participants. Fifty dreams and their interpretations were collected from participants, who were traditional healers and their clients. A phenomenological methodology was adopted in explicating the data. Themes explicated included : the physiognomy of the dreamer's life-world as revealed by significant dreams, the interpretation of significant dreams as revealed through action, and human bodiliness as revealed in dream interpretations. The participants' approach to dreams is not based upon an explicit theory, but upon an immediate and pathic understanding of the dream phenomenon. The understanding is based upon the interpreter's concrete understanding of the life-world, which includes the possibility of cosmic integration and continuity between personal and trans-personal realms of being

Cost-effectiveness analysis of a kidney and cardiovascular disease treatment program in an Australian Aboriginal population

The objective of the study was to assess, from a health service perspective, whether a systematic program to modify kidney and cardiovascular disease reduced the costs of treating end-stage kidney failure. The participants in the study were 1,800 aboriginal adults with hypertension, diabetes with microalbuminuria or overt albuminuria, and overt albuminuria, living on two islands in the Northern Territory of Australia during 1995 to 2000. Perindopril was the primary treatment agent, and other medications were also used to control blood pressure. Control of glucose and lipid levels were attempted, and health education was offered. Evaluation of program resource use and costs for follow-up periods was done at 3 and 4.7 years. On an intention-to-treat basis, the number of dialysis starts and dialysis-years avoided were estimated by comparing the fate of the treatment group with that of historical control subjects, matched for disease severity, who were followed in the before the treatment program began. For the first three years, an estimated 11.6 person-years of dialysis were avoided, and over 4.7 years, 27.7 person-years of dialysis were avoided. The net cost of the program was 1,210 dollars more per person per year than status quo care, and dialyses avoided gave net savings of 1.0 million dollars at 3 years and 3.4 million dollars at 4.6 years. The treatment program provided significant health benefit and impressive cost savings in dialysis avoided.

Dutch tilt, Aussie auteur : the films of Rolf de Heer. 2nd ed.

Dutch-born Australian director, Rolf de Heer, is Australia's most successful and unpredictable film-maker, with thirteen feature films of widely varying style and genre to his name. Arising from the author's 2006 - 2009 PhD research at the Queensland University of Technology (which focussed on the psychoanalytic use of sound in his films), and a fixed term Research Fellowship at the National Film and Sound Archive in Canberra, Australia, "Dutch Tilt, Aussie Auteur: The Films of Rolf de Heer" was first published in 2009 by VDM in Saarbrucken, Germany. This second edition addresses de Heer's additional film-making since 2009, and as with the first edition, is an auteur analysis of the thirteen feature films he has directed (and mostly written and produced). The book explores the theoretical instability of the concept of auteurism and concludes that there is a signature world view to be detected in his oeuvre, and that de Heer (quite possibly unconsciously) promotes unlikely protagonists who are non-hyper masculine, child-like and nurturing, as opposed to the typical Hollywood hero who is macho, exploitative and hyper masculine. Rolf de Heer was born in Heemskerk, Holland, in 1951 and migrated to Australia with his family in 1959. He spent seven years working for the ABC before gaining entry to Australia's Film, Television and Radio School, where he studied Producing and Directing. From his debut feature film after graduating, the children's story about the restoration of a Tiger Moth biplane, "Tail of a Tiger" (1984) to his breakout cult sensation "Bad Boy Bubby" (1993) which "tore Venice [Film Festival] apart" to the first Aboriginal Australian language film "Ten Canoes" (2006) which scooped the pool at the Australian Film Institute awards, de Heer has consistently proven himself unpredictable. This analysis of his widely disparate films, however, suggests that Australia's most innovative film-maker has a signature pre-occupation with giving a voice to marginalised, non-hyper masculine protagonists. Demonstrating a propensity to write and direct in a European-like style, his 'Dutch tilt' is very much not Hollywood, but is nevertheless representative of a typically Aussie world-view.

The human dimension of nosocomial wound infection : a study in liminality

Nosocomial wound infection is a disease that has to date been primarily understood through the language of science and biomedicine. This paper reports on findings from a sociological, interpretive study that focused on the experiential dimension of this phenomenon. The illness experience of a nosocomial wound infection is examined within a cultural milieu that values the smooth, untroubled body and alternatively ascribes cultural meaning to a body that has a definable illness. Within this context the person with a chronic wound from nosocomial infection defies normative categorisation and is thus situated outside the patterning of society. The human dimension of nosocomial wound infection includes the private, existential and embodied aspects of living with a chronic, infected wound. This report indicates that the experiential dimension is characterised by an embodied state of liminality. People with this illness live an indeterminate existence that is in-between health and illness, cure and disease. As such they have no recognised place in the medical or social world.

Making sense of mental illness as a full human experience : Perspective of illness and recovery held by people with a mental illness living in the community.

Recovery is a highly contextualized concept amid divergent interpretations and unique experiences. There is substantial current interest in building evidence about recovery from mental illness in order to inform best practice founded in the ways people find to live productive and meaningful lives. This paper presents some accounts related to recovery and illness expressed by eight people through a Participatory Action Research project. The research facilitated entry to the subjective experiences of living in the community as an artist with a mental illness. The people in the research shared an integrated understanding of illness, recovery and identity. Their understanding provided insight into mental illness as an inseparable aspect of who they were. Further, specific issue was raised of recovery as a clinical term with a requirement to meet distinct conventions of recovery. This paper emphasizes that being ill and being well, for the person with a mental illness, is a dynamic and complex development not easily explained or transformed into uniform process or outcomes. Attempts to establish an integral or consensual approach to recovery has, to date, disregarded mental illness as a full human experience. This paper argues that broader frameworks for thinking and responding to the dynamic processes of mental illness and recovery are needed and require acknowledgment of competing and contradictory ideas.

A qualitative study of the determinants of dieting and non-dieting approaches in overweight/obese Australian adults.

Background Dieting has historically been the main behavioural treatment paradigm for overweight/obesity, although a non-dieting paradigm has more recently emerged based on the criticisms of the original dieting approach. There is a dearth of research contrasting why these approaches are adopted. To address this, we conducted a qualitative investigation into the determinants of dieting and non-dieting approaches based on the perspectives and experiences of overweight/obese Australian adults. Methods Grounded theory was used inductively to generate a model of themes contrasting the determinants of dieting and non-dieting approaches based on the perspectives of 21 overweight/obese adults. Data was collected using semi-structured interviews to elicit in-depth individual experiences and perspectives. Results Several categories emerged which distinguished between the adoption of a dieting or non-dieting approach. These categories included the focus of each approach (weight/image or lifestyle/health behaviours); internal or external attributions about dieting failure; attitudes towards established diets, and personal autonomy. Personal autonomy was also influenced by another category; the perceived knowledge and self-efficacy about each approach, with adults more likely to choose an approach they knew more about and were confident in implementing. The time perspective of change (short or long-term) and the perceived identity of the person (fat/dieter or healthy person) also emerged as determinants of dieting or non-dieting approaches respectively. Conclusions The model of determinants elicited from this study assists in understanding why dieting and non-dieting approaches are adopted, from the perspectives and experiences of overweight/obese adults. Understanding this decision-making process can assist clinicians and public health researchers to design and tailor dieting and non-dieting interventions to population subgroups that have preferences and characteristics suitable for each approach.

Mediating identity narratives : a case study in queer digital storytelling as everyday activism

Digital Stories are short autobiographical documentaries, often illustrated with personal photographs and narrated in the first person, and typically produced in group workshops. As a media form they offer ‘ordinary people’ the opportunity to represent themselves to audiences of their choosing; and this amplification of hitherto unheard voices has significant repercussions for their social participation. Many of the storytellers involved in the ‘Rainbow Family Tree’ case study that is the subject of this paper can be characterised as ‘everyday’ activists for their common desire to use their personal stories to increase social acceptance of marginalised identity categories. However, in conflict with their willingness to share their personal stories, many fear the risks and ramifications of distributing them in public spaces (especially online) to audiences both intimate and unknown. Additionally, while technologies for production and distribution of rich media products have become more accessible and user-friendly, many obstacles remain. For many people there are difficulties with technological access and aptitude, personal agency, cultural capital, and social isolation, not to mention availability of the time and energy requisite to Digital Storytelling. Additionally, workshop context, facilitation and distribution processes all influence the content of stories. This paper explores the many factors that make ‘authentic’ self-representation far from straight forward. I use qualitative data drawn from interviews, Digital Story texts and ethnographic observation of GLBTQIS participants in a Digital Storytelling initiative that combined face-to-face and online modes of participation. I consider mediating influences in practice and theory and draw on strategies put forth in cultural anthropology and narrative therapy to propose some practical tools for nuanced and sensitive facilitation of Digital Storytelling workshops and webspaces. Finally, I consider the implications of these facilitation strategies for voice, identity and social participation.

Pulse Gauntlets

To feel another person’s pulse is an intimate and physical interaction. In these prototypes we use near field communications to extend the tangible reach of our heart beat, so another person can feel our heart beat at a distance. The work is an initial experiment in near field haptic interaction, and is used to explore the quality of interactions resulting from feeling another persons pulse. The work takes the form of two feathered white gauntlets, to be worn on the fore arm. Each of the gauntlets contain a pulse sensor, radio transmitter and vibrator. The pulse of the wearer is transmitted to the other feathered gauntlet and transformed into haptic feedback. When there are two wearers, their heart beats are exchanged. To be felt by of each other without physical contact.

Life writing

Two hundred years ago life writing was already highly popular in the form of autobiography, memoir, biography, journals, essays and diaries. It now commands a huge share of the publishing market, as there is an enormous demand from readers for narratives based directly on 'real lives'. There is a lot of common ground between the two main forms - autobiography/memoir and biography: both require skilled storytelling [rather than listing facts and events], research and imagination. The quality of the writing itself is crucial to the impact on the reader. A person can have an existing, worthy life but unfortunately write about it (or be written about) in a dull way. And how a person is remembered and valued can be a factor of life writing about or by them. This chapter will define and contextualise life writing, look at specific detailed examples, and offer guidance on how to write effectively.

Can we deliver both population-based and personalized approaches to cancer care?

Responding to the individual needs of the person affected by cancer is a fundamental tenet of nursing care. The evidence base to enable highly personalized approaches to the way we provide care has grown enormously in recent years. Today, we have a much better understanding of the mechanisms underpinning health needs of people with cancer, as well as the wide range of environmental, sociocultural, psychological, and biological influences on these needs. This growing evidence base enables us to better target and tailor interventions in increasingly sophisticated ways.

Existential place-making : the dialogical realms of design for dwelling with disability

The world of disability is often neglected or taken for granted in able-bodied society. Apart from the challenge that disability is a social construct (Linton, 1998, 2006; Longmore, 2003; Thompson, 1997) there is an impact on the people with disability that they either feel left out or they don’t belong in the larger community. The able-bodied community is also left with very little knowledge or no sensitivity towards people with disability. These internal whirlpools do not contribute to any community only to create larger gaps and higher differences between the groups of people. Peace (2010) claims that disability is something imposed on to a person on top of a physical impairment. Nord (2008) advocates that while environmental barriers and social attitudes are crucial aspects of a person’s experience, they can indeed disable a person. The study reported high-lights what is home for people with disability and their family members. The way the person with disability and family members without disability share the same home and nurture personal relationships with each other demands greater attention. This research sheds light on the intricate relationships that exists between the family members including person with disability and their built environment. These existential connections provide a holistic viewpoint and the glimpse into the lived experiences of homes for people with disability and their care-givers. Concepts of universal design or barrier free design have not been successful (Connell and Sanford, 1999) in revealing in-depth the nature of place-making for people with disability and their care-givers. Such studies fail to incorporate the holistic needs of individuals with disability and their family members in terms of their bodily, visceral, emotional, social, psycho-social, intuitive, spiritual and temporal needs, to name a few (Franz, Bitner, 2010). This paper reports on some preliminary findings on phenomena of dwelling for people with different kinds of disability and their care-givers sharing the same home from an interior design perspective.

Fast Friends

Two works were included in the curated exhibition "Fast Friends" at the Nona Gallery, at the Brisbane Institute of Art. This exhibition was the the second of three exhibitions. This project curated by Jill Barker was collectively entitled "Pace" and was supported by an Arts Queensland grant. The premise for the exhibition and for the work creatied for the exhibiton is as follows. For fast friends the pieces will be works that consist of more than one part. In the way that a friendship consists of more than one person. You could say that the location of a friendship lies somewhere between the friends - so in each of the artworks in fast friends, the 'centre' of the work - if it can be said to have a centre - will be in the relationship between the parts.