Ensuring quality during monitoring of the learning environment of government primary schools achieved through EUI-PDP for teachers and head teachers

A positive change in the learning environment in schools is visible through ongoing professional development of teachers and administrators. Monitoring the professional development program and providing support to teachers and administrators to transfer their learnings into the school environment ensures some measures of quality. Quality issues led to the launching of the Professional Development Program (PDP) for Primary School Teachers (PSTs) of Sindh by the United Educational Initiative (UEI), a consortium of five Governmental and Non-Governmental Organizations, working under the supervision of Education Sector Reform Assistance (ESRA). Implementation of the UEI-PDP in four districts of Sindh, is ensured by a team of professionals in each district. Recognising that capacity building of district education employees would improve the educational system in the country, 130 Master Trainers were selected, on merit, from the District Education Office for the training of 17,000 teachers and 3000 Head teachers/administrators over a period of two years. This paper developed the design of a Monitoring Process for a Professional Development Program for Primary School Teachers and Administrators. Data was collected through Pre/Post observations, Interviews, Questionnaires and Reports. Such tools make it possible for the monitoring teams to observe, to inquire further, and, along with the Managers, Master Trainers and School Support Team, seek to explain the progress of the program and take corrective action where indicated. Both formative evaluations as well as summative  evaluation techniques are utilized for evaluating the program. The monitoring process that assisted in formative evaluations is described. In order to assist in summative evaluation, data collected through the monitoring process was further developed to categorize the schools where teachers and head teachers are trained. It is hoped that the categorization of the schools may lead to further improvements in those schools which fall in the group for need improvement. It may also initiate further research as to reasons behind why some schools are in the good category and why others fall in the average category.

Is rehabilitation associated with change in functional status among nursing home residents?

Assessing functional status of residents in nursing homes is one way to evaluate the quality of care provided. The purpose of this study was to investigate whether rehabilitation interventions could lead to improved functional independence. A prospective study was carried out to examine the change in activities of daily living (ADL) of 310 residents aged 65 or above over a period of 6 months. About 41.3% (n = 128) received rehabilitation therapy. Functional improvement was observed in 30.6% of the participants. The corresponding figures for stabilization and functional decline were 45.2% and 24.2%, respectively. Using a multinomial logistic regression, we found that factors significantly associated with change in functional status included baseline ADL score, family visit, number of beds in the institution, and transfer to acute hospitals. After adjusting for these confounding variables, change in functional status of those who received rehabilitation and those who did not was not significantly different.

School and anaemia prevention: current reality and opportunities - a Tanzanian case study

Iron deficiency anaemia is highly endemic in rural areas of Tanzania and in many developing countries. Its prevention among school children requires greater dissemination of knowledge of anaemia among children, teachers, parents and the general community. Associated improvements in the hygienic status of domestic and school environments are also often required. One-hundred-and-thirty-one anaemic children, 90 parents and 76 teachers were interviewed to ascertain their understanding of anaemia. Most children and parents had little knowledge of the symptoms, causes and prevention of anaemia. In addition to their iron-deficient diets, more than half of the children went to school without something to eat at breakfast and during school hours. However, parents and teachers were willing to work together to provide meals for the children. Poor sanitation in the children's homes and in schools was a little recognized factor which could pose a serious risk of anaemia. In addition, inadequate sanitation facilities and poor quality of physical environment prevailed both in the children's homes and in schools. The findings suggest the need for the establishment of a health-promoting schools network to provide a comprehensive framework for health promotion in schools as well as in homes in Tanzania and in other developing countries. Schools can be an ideal setting to positively influence a community's health status. Partnerships among teachers, parents and the wider community are required to identify, prioritize and ameliorate health problems.

Features of public open spaces and physical activity among children : findings from the CLAN study

Objective : To examine associations between features of public open spaces, and children's physical activity.
Participants : 163 children aged 8–9 years and 334 adolescents aged 13–15 years from Melbourne, Australia participated in 2004.
Methods : A Geographic Information System was used to identify all public open spaces (POS) within 800 m of participants' homes and their closest POS. The features of all POS identified were audited in 2004/5. Accelerometers measured moderate-to-vigorous physical activity (MVPA) after school and on weekends. Linear regression analyses examined associations between features of the closest POS and participants' MVPA.
Results : Most participants had a POS within 800 m of their home. The presence of playgrounds was positively associated with younger boys' weekend MVPA (B = 24.9 min/day; p ≤ 0.05), and lighting along paths was inversely associated with weekend MVPA (B = − 54.9 min/day; p ≤ 0.05). The number of recreational facilities was inversely associated with younger girls' MVPA after school (B = − 2.6 min/day; p ≤ 0.05) and on the weekend (B = − 8.7 min/day; p ≤ 0.05). The presence of trees providing shade (5.8 min/day, p ≤ 0.01) and signage regarding dogs (B = 6.8 min/day, p ≤ 0.05) were positively associated with adolescent girls' MVPA after school.
Conclusion : Certain features of POS were associated with participants' MVPA, although mixed associations were evident. Further research is required to clarify these complex relationships.

The moral imperative of designating patient safety and quality care as a national nursing research priority

Since the early 1990s, research studies conducted respectively in the USA, UK and Australia have found that between 4 and 16.6 per cent of patients suffer from some kind of harm (including permanent disability and death) as a result of human errors and adverse events while in hospital. It has been further estimated that approximately 50 per cent of these human errors/adverse events resulting in harm could have been prevented. In response to the significant financial, social, and political implications of these figures, a range of processes have been put in place in an attempt to improve patient safety and quality care in Australia. Nonetheless, it is evident that more can be done to improve the status quo. One process that warrants consideration is that of peak health professional groups and organisations providing active leadership in the promotion of patient safety, such as by making a visible and recognisable commitment to patient safety as a strategic research priority area. In this paper it is contended that, given the moral importance of patient safety and quality care in nursing and related health care domains, the inseparable link between nursing practice and patient safety, and the central role that research has to play in driving safety improvements in these domains, it is morally imperative that the nursing profession gives sustained and focussed public attention to patient safety and quality care as a national research priority.

The ethics and practical importance of defining, distinguishing and disclosing nursing errors : a discussion paper

Nurses globally are required and expected to report nursing errors. As is clearly demonstrated in the international literature, fulfilling this requirement is not, however, without risks. In this discussion paper, the notion of ‘nursing error’, the practical and moral importance of defining, distinguishing and disclosing nursing errors and how a distinct definition of ‘nursing error’ fits with the new ‘system approach’ to human-error management in health care are critiqued. Drawing on international literature and two key case exemplars from the USA and Australia, arguments are advanced to support the view that although it is ‘right’ for nurses to report nursing errors, it will be very difficult for them to do so unless a non-punitive approach to nursing-error management is adopted.

Nursing and being nursed from patients' perspectives : an ethnographic study

The research was commenced to understand why patients submissively accept compliance in the nursing relationship. To understand this phenomenon, an anthropological perspective about nursing was sought through ethnographic processes, utilising The Ethnographic Research Cycle and The Developmental Research Sequence as detailed by James Spradley (1980). Ethnographic methods of fieldwork and participant observation were undertaken over a three month period in a district nursing service in a rural area of Victoria, Australia. There are three over arching aims. The first is to record information at risk of being lost, hence the ethnography is an archival record describing insiders' perspectives of nursing practice. Description brings into view broad contextual issues that shape nursing practice, the daily routines and cultural norms of nursing, whilst also giving voice to patients' experiences about being nursed. The early part of the thesis is descriptive of the mundanity of nursing practice and of being a patient as these interactions are of fundamental significance in giving meaning to people's lives. Secondly the inquiry seeks to capture the meaning patients attach to nursing. Further description continued to uncover perspectives of nursing that were layered to present an integrated whole that still acknowledges the integrity of individuals and structures that make up that whole. As the cultural picture gained detail, the expected norms of being a nurse and a patient became evident, revealing how culture gives shape to nursing and being nursed. Notions of time and space were found to be constructs of being a patient which shape the illness experience. They are not necessarily within a patient's control, nonetheless, there is a norm and deviation from this norm has consequences for patients. Thirdly, the ethnography conveys the expected behaviour for a person who becomes a patient, to make known the implicit meanings, norms of behaviour and unwritten rules that a patient needs to understand as they pass through various stages of the health care system. In conclusion, the ethnography consistently reveals the underlying conflict between what nurses believe they do and the meaning attached to the experience of being nursed. For example, some nurses practice with patients' values as central to practice; others believe they care, yet observation and patient conversations suggest that they do not. The ethnography revealed that society expects nurses to elicit and reinforce compliance. Similarly, the power of culture shapes the experience of patients as the desire to be accepted, as a personal need, and as a means of having their nursing needs met, means that patients will invariably be passively compliant. The consequence is that nurses have a dominant power differential over patients, therefore, if nursing is to continue to describe practice as humanistic and caring, they ought to actively seek to be aware of patients' values and be motivated to accept these as central to practice.

Public reporting of nursing home quality of care : Lessons from the United States experience for Canadian policy discussion

While the demand for continuing care services in Canada grows, the quality of such services has come under increasing scrutiny. Consideration has been given to the use of public reporting of quality data as a mechanism to stimulate quality improvement and promote public accountability for and transparency in service quality. The recent adoption of the Resident Assessment Instrument (RAI) throughout a number of Canadian jurisdictions means that standardized quality data are available for comparisons among facilities across regions, provinces and nationally. In this paper, we explore current knowledge on public reporting in nursing homes in the United States to identify what lessons may inform policy discussion regarding potential use of public reporting in Canada. Based on these findings, we make recommendations regarding how public reporting should be progressed and managed if Canadian jurisdictions were to implement this strategy.

Agency-nursing work : perceptions and experiences of agency nurses

This paper explores agency-nursing work from the perspective of agency nurses to gain in-depth understanding of their clinical practice, their relationships with the employing agency, hospitals and permanent nurses, and their professional status. For this study, individual interviews were conducted with ten agency nurses who were registered with one of three nursing agencies in Melbourne, Australia. Five major themes emerged from interview data: orientation, allocation of agency nurses, reasons for doing agency-nursing work, experiences with hospital staff, and professionalism. The findings reveal that the primary reason for nurses engaging in agency-nursing work is for the flexibility it offers. While agency nurses described a commitment to professionalism, the findings emphasise the need to establish effective communication networks between agency nurses, nursing agencies and hospital institutions. Such communication between stakeholders is important to facilitate discussion of issues such as appropriate notification of shift availability, appropriate assignment of work and recognition of the agency nurse as a valuable member of the health care team. In particular, the findings highlight the importance of comprehensive orientation and education for agency nurses to shift the focus of their daily work from task completion to more comprehensive patient care.

Fall risk management intervention : a feasibility and validation study

A fall risk management intervention was undertaken by staff caring for older people in nursing homes. Its acceptability and usefulness was tested. 'High risk times' and 'at risk' individuals were found, thereby identfying times when staff should be vigilant, and specific residents to be targeted with fall prevention strategies.

The clinical utility of a suite of continence assessment tools for use in residential aged care facilities

According to the Institute of Medicine of the National Academies, 80% of direct care in nursing homes in the USA is provided by workforce that has least formal education about patient care (1). This situation is echoed in Australian residential aged care facilities where the day-to-day management is largely provided by unregulated workers (i.e. nursing assistants, personal carers and nursing aides) and is overseen by registered nurses. Some facilities additionally have access to expert advice from continence nurse advisors. In order to assist the residential aged care workforce to provide continence care that is evidence-based, a team of researchers developed and trialled a suite of continence assessment tools that were mainly targeted to unregulated workers. This paper presents information on the development of the tools (Stage 1) and on their evaluation (Stage 2).

Clinical nurse research consultant : a clinical and academic role to advance practice and the discipline of nursing

Aims:  This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role. Background:  Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians. Data sources:  International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant. Discussion:  The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus. Implications for nursing:  Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support. Conclusion:  The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.

Residents' perspectives on urinary incontinence : a review of literature

Background: Individuals in residential aged care facilities experience urinary incontinence more than any other single population. Despite these factors, the impact of the condition on their quality of life, their perspectives of living with the condition, and their preferences for care have received little research attention.

Aim: To provide a descriptive overview of research about; the impact of urinary incontinence on residents’ quality of life; residents’ perspectives of having urinary incontinence; and their preferences for continence care’.

Design: A descriptive review of literature.

Method: A broad search was undertaken for qualitative and quantitative research that evaluated residents’ quality of life related to urinary incontinence; their perspectives on having urinary incontinence, and their preferences for managing it. Data were displayed in tabular format, summarized, and described.

Results: Ten studies were identified and reviewed (six qualitative and four quantitative). They reveal many residents’ value having independent bowel and bladder function, but believe that incontinence in inevitable and intractable. Some adopt self management strategies, however considerable barriers hinder their ability to maintain continence and manage incontinence. Residents often have low expectations, and hence decline further evaluation and treatment. Some express satisfaction with continence care even if this care is not consistent with their preferences. Little is known about how cognitively impaired residents perceive their condition. However some individuals with cognitive impairment respond with acute anxiety when carers’ attempt to provide continence care.

Conclusion: Residents’ perspectives on incontinence and preferences for continence care relate to low expectations for improvement. Such misconceptions should be addressed and residents and their family members should be given a range of options from which to choose. As urinary incontinence impacts on residents’ quality of life, it is also important that continence care is delivered in a participative and sensitive way.

Privacy and the access of information in a smart house environment

In this paper we present a framework for addressing privacy issues raised by the monitoring of assisted living smart house environments. In home environments, the conflict between the goals of the surveillance, and the private nature of the home, raises the issue of occupant privacy. This issue needs to be addressed if applications are to be accepted by the occupant. We identify four key properties required for the design of privacy sensitive ubiquitous computing applications. Subsequently, we develop a dynamic and flexible method for implementing privacy measures through controlling access to data, and an interface to provide feedback to the occupant, enabling them to control the implemented privacy measures. We form a generic framework for implementing privacy sensitive ubiquitous computing applications based on previous applications within the field. This framework was then extended and used to develop a specific framework for a privacy sensitive smart house. The approach proposed in the framework dynamically applies privacy measures to multi-modal data according to the situation, or context, of the environment. We further test an implementation of the privacy measures, and detail methods to implement feedback and control. The approach aims to decrease the invasiveness of the surveillance, while retaining the purpose of the assisted living environment.