Grunt language versus accent : the perceived communication barriers between international medical graduates and patients in Central Wheatbelt catchments

Due to the chronic shortages of GPs in Australian rural and remote regions, considerable numbers of international medical graduates (IMG) have been recruited. IMG experience many difficulties when relocating to Australia with one of the most significant being effective GP-patient communication. Given that this is essential for effective consultation it can have a substantial impact on health care. A purposive sample of seven practising GPs (five IMG, two Australian-trained doctors (ATD)) was interviewed using a semistructured face-to-face interviewing technique. GPs from Nigeria, Egypt, United Kingdom, India, Singapore and Australia participated. Interviews were transcribed and then coded. The authors used qualitative thematic analysis of interview transcripts to identify common themes. IMG-patient communication barriers were considered significant in the Wheatbelt region as identified by both IMG and ATD. ATD indicated they were aware of IMG-patient communication issues resulting in subsequent consults with patients to explain results and diagnoses. Significantly, a lack of communication between ATD and IMG also emerged, creating a further barrier to effective communication. Analysis of the data generated several important findings that rural GP networks should consider when integrating new IMG into the community. Addressing the challenges related to cross-cultural differences should be a priority, in order to enable effective communication. More open communication between ATD and IMG about GP-patient communication barriers and education programs around GP-patient communication would help both GP and patient satisfaction.

Communication and the casualisation of nursing : a critical ethnography

The contemporary working environment is being rapidly reshaped by technological, industrial and political forces. Increased global competitiveness and an emphasis on productivity have led to the appearance of alternative methods of employment, such as part-time, casual and itinerant work, allowing greater flexibility. This allows for the development of a core permanent staff and the simultaneous utilisation of casual staff according to business needs. Flexible workers across industries are generally referred to as the non-standard workforce and full-time permanent workers as the standard workforce. Even though labour flexibility favours the employer, increased opportunity for flexible work has been embraced by women for many reasons, including the gender struggle for greater economic independence and social equality. Consequently, the largely female nursing industry, both nationally and internationally, has been caught up in this wave of change. This ageing workforce has been at the forefront of the push for flexibility with recent figures showing almost half the nursing workforce is employed in non-standard capacity. In part, this has allowed women to fulfil caring roles outside their work, to ease off nearing retirement and to supplement the family income. More significantly, however, flexibility has developed as an economic management initiative, as a strategy for cost constraint. The result has been the development of a dual workforce and as suggested by Pocock, Buchanan and Campbell (2004), associated deep-seated resentment and the marginalisation of part-time and casual workers by their full-time colleagues and managers. Additionally, as nursing currently faces serious recruitment and retention problems there is urgent need to understand the factors which are underlying present discontent in the nursing profession. There is an identified gap in nursing knowledge surrounding the issues relating to recruitment and retention. Communication involves speaking, listening, reading and writing and is an interactive process which is central to the lives of humans. Workplace communication refers to human interaction, information technology, and multimedia and print. It is the means to relationship building between workers, management, and their external environment and is critical to organisational effectiveness. Communication and language are integral to nursing performance (Hall, 2005), in twenty-four hour service however increasing fragmentation due to part-time and casual work in the nursing industry means that effective communication management has become increasingly difficult. More broadly it is known that disruption to communication systems impacts negatively on consumer outcomes. Because of this gap in understanding how nurses view their contemporary nursing world, an interpretative ethnographic study which progressed to a critical ethnographic study, based on the conceptual framework of constructionism and interpretativism was used. The study site was a division within an acute health care facility, and the relationship between increasing casualisation of the nursing workforce and the experiences of communication of standard and non-standard nurses was explored. For this study, full-time standard nurses were those employed to work in a specific unit for forty hours per week. Non-standard nurses were those employed part-time in specific units or those nurses employed to work as relief pool nurses for shift short falls where needed. Nurses employed by external agencies, but required to fill in for shifts at the facility were excluded from this research. This study involved an analysis of observational, interview and focus group data of standard and non-standard nurses within this facility. Three analytical findings - the organisation of nursing work; constructing the casual nurse as other; and the function of space, situate communication within a broader discussion about non-standard work and organisational culture. The study results suggest that a significant culture of marginalisation exists for nurses who work in a non-standard capacity and that this affects communication for nurses and has implications for the quality of patient care. The discussion draws on the seven elements of marginalisation described by Hall, Stephen and Melius (1994). The arguments propose that these elements underpin a culture which supports remnants of the historically gendered stereotype "the good nurse" and these cultural values contribute to practices and behaviour which marginalise all nurses, particularly those who work less than full-time. Gender inequality is argued to be at the heart of marginalising practices because of long standing subordination of nurses by the powerful medical profession, paralleling historical subordination of women in society. This has denied nurses adequate representation and voice in decision making. The new knowledge emanating from this study extends current knowledge of factors surrounding recruitment and retention and as such contributes to an understanding of the current and complex nursing environment.

Sustainable knowledge community precincts : lessons from global best practices

In the era of global knowledge economy, urban regions—seeking to increase their competitive edge, become destinations for talent and investment, and provide prosperity and quality of life to their inhabitants—have little chance achieving their development goals without forming effective knowledge-based urban development (KBUD) strategies. KBUD paradigm suggests that the economic future of cities increasingly depends on the capacity to attract, generate, retain and foster creativity, knowledge and innovation—and make space and place for knowledge generation and knowledge communities. Thus, the paper aims to shed light on the planning and development processes of the KBUD phenomenon with respect to the construction of sustainable knowledge community precincts (KCPs) aimed at making space for knowledge generation and place for knowledge communities—and provide useful lessons for the developing country cities seeking such sustainable and KBUD.

Establishing design thinking : accident, program frameworks and personal practices

Distribution through electronic media provides an avenue for promotion, recognition and an outlet of display for graphic designers. The emergence of available media technologies have enabled graphic designers to extend these boundaries of their practice. In this context the designer is constantly striving for aesthetic success and is strongly influenced by the fashion and trends of contemporary design work. The designer is always in a state of inquiry, finding pathways of discovery that lead to innovation and originality that are highly valued criteria for self-evaluation. This research is based on an analysis of the designer perspective and the processes used within an active graphic design practice specializing entirely within a digital collage domain. Contemporary design methodologies were critically examined, compared and refined to reflect the self-practice of the researcher. The refined methodology may assist designers in maintaining systematic work practices, as well as promote the importance of exploration and experimentation processes. Research findings indicate some differences in the identified methodologies and the design practice of the researcher in the sense that many contemporary designers are not confined to a client-base but are self-generating design images influenced by contemporary practitioners. As well as confirming some aspects of more conventional design processes, the researcher found that accidental discoveries and the designer’s interaction with technology plays a significant part in the design process.

Standardisation of plant and machinery valuation practices in Malaysia

Plant and machinery valuation is important to every company.s annual financial reporting. It is reported under the non-current assets section, and the valuers are generally employed to provide the up to date valuation of the non-current assets valuation such as property, plant and equipment that can make up to 80% of the total assets of a company. The valuation of plant and machinery is also important for other purposes such as securing loan facilities, sales, takeover, insurance and auction. The application of 2005 International Financial Reporting Standard (IFRS) has a subsequent impact on the financial sector, as a whole. The accountants have to choose between the Historical Cost approach and Market Value approach in determining the value of the client.s assets. In Malaysia, the implementation of IFRS has a domino effect on the financial system, especially for plant and machinery valuation for financial reporting. The comparison data for plant and machinery valuation is limited unlike land and building valuation. The question of Malaysian valuer.s ability to comply with the IFRS standard keeps rising every day, not just to the accountants, but also other related parties such as financial institutions, government agencies and the clients. This is happening because of different interpretations of premise of value for plant and machinery, as well as methods been used and differences in standards of reporting among the valuers conducting plant and machinery valuation. The root of the problem lies in the lack of practical guidelines governing plant and machinery valuation practices and different schools of thought among the valuers. Some follow the United Kingdom.s RICS guidelines, whilst some valuers are more comfortable with the United State.s USPAP rules, especially on the premise of value. This research is to investigate the international best practices of plant and machinery valuation and to establish the common valuation concept, awareness and application of valuation methodology and valuation process for plant and machinery valuation in Malaysia. This research uses a combination of the qualitative and quantitative research approach. In the qualitative approach, the content analyses were conducted from the international practices and current Malaysian implementation of plant and machinery valuation. A survey (quantitative approach) via questionnaire was implemented among the registered and probationary valuers in Malaysia to investigate their understanding and opinion relating to plant and machinery valuation based on the current practices. The significance of this research is the identification of international plant and machinery practices and the understanding of current practices of plant and machinery valuation in Malaysia. It is found that issues embedding plant and machinery valuation practices are limited numbers of resources available either from scholars or practitioner. This is supported by the general finding from the research survey that indicates that there are immediate needs for practical notes or guidelines to be developed and implemented to support the Malaysian valuers practising plant and machinery valuation. This move will lead to a better understanding of plant and machinery valuation, reducing discrepancies in valuation of plant and machinery and increased accuracy among practising valuers.

Outcomes of an early feeding practices intervention to prevent childhood obesity

Objective Use a randomised controlled trial (RCT) to evaluate outcomes of a universal intervention to promote protective feeding practices, which commenced in infancy and aimed to prevent childhood obesity Subjects and Methods The NOURISH RCT enrolled 698 first-time mothers (mean age 30.1 years, SD=5.3) with healthy term infants (51% female) aged 4.3 (SD=1.0) months at baseline. Mothers were randomly allocated to self-directed access to usual care or to attend two 6-session interactive group education modules that provided anticipatory guidance on early feeding practices. Outcomes were assessed six months after completion of the second information module, 20 months from baseline and when the children were two years old. Maternal feeding practices were self-reported using validated questionnaires and study-developed items. Study-measured child height and weight were used to calculate BMI Z-score. Results Retention at follow-up was 78%. Mothers in the intervention group reported using responsive feeding more frequently on 6/9 subscales and 8/8 items (Ps ≤.03) and overall less ‘controlling feeding practices’ (P<.001). They also more frequently used feeding practices (3/4 items; Ps <.01) likely to enhance food acceptance. No statistically significant differences were noted in anthropometric outcomes (BMI Z-score: P=.11), nor in prevalence of overweight/obesity (control 17.9% vs. intervention 13.8%, P=.23). Conclusions Evaluation of NOURISH at child age two years found that anticipatory guidance on complementary feeding, tailored to developmental stage, increased use by first-time mothers of 'protective' feeding practices that potentially support the development of healthy eating and growth patterns in young children.

The SCOOT experience : games in place : collaborative interventions in socio-spatial practices

The principal focus of this thesis is the representation of a significant creative practice in relation to the design and installation of the Location-Based Game, SCOOT. This project demonstrates new understandings relating to the contingencies and potentials for transferring positive aspects of digital gameplay to everyday physical environments in an effort to reveal hidden histories and revitalise peoples’ interactions with their local urban spaces.

The architecture of children’s use of language and tools when problem solving collaboratively with robotics

This paper demonstrates, following Vygotsky, that language and tool use has a critical role in the collaborative problem-solving behaviour of school-age children. It reports original ethnographic classroom research examining the convergence of speech and practical activity in children’s collaborative problem solving with robotics programming tasks. The researchers analysed children’s interactions during a series of problem solving experiments in which Lego Mindstorms toolsets were used by teachers to create robotics design challenges among 24 students in a Year 4 Australian classroom (students aged 8.5–9.5 years). The design challenges were incrementally difficult, beginning with basic programming of straight line movement, and progressing to more complex challenges involving programming of the robots to raise Lego figures from conduit pipes using robots as pulleys with string and recycled materials. Data collection involved micro-genetic analysis of students’ speech interactions with tools, peers, and other experts, teacher interviews, and student focus group data. Coding the repeated patterns in the transcripts, the authors outline the structure of the children’s social speech in joint problem solving, demonstrating the patterns of speech and interaction that play an important role in the socialisation of the school-age child’s practical intellect.

Multimodality, media, and access to multiliteracies

In many English-speaking countries bilingual and multilingual speakers of English are integrated into mainstream classrooms, where the teacher is expected to help them “catch up” with speakers of the dominant language. In this presentation, I argue that we teach in culturally and linguistically diverse societies that are increasingly interconnected through a broadened range of multimodal and digital textual practices. Intuitively, one might expect that multimodal approaches are more equitable than exclusively print-based approaches because learners can draw from a broader range of semiotic resources. Yet the potentials of using multiple modes and new digital media to provide greater access to multiliteracies cannot be assumed. I draw on a case study of a multilingual language learner, Paweni, a Thai immigrant, describing how she and her peers negotiated cultural and linguistic difference. These encounters occur during multiliteracies lessons involving both print and digital texts. I theorise a “dialectic of access” to explain the reciprocal interaction between the agency of learners, modes, and media. I apply Giddens’ structuration theory to take into account the social structures – domination, signification, and legitimation – that played an important role in this dialectic of access.

CUOL – "See You Online" : teaching strategies for digital literacy practices in the English curriculum

Literacy educator Kathy Mills, observes that creating multimodal and digital texts is an essential part of the national English curriculum in Australia. Here, she presents five practical and engaging ways to transform conventional writing tasks in a digital world.

Socio-Spatial Approaches To Literacy Studies: Rethinking the Social Constitution and Politics of Space

Literacy studies have begun to examine the spatial dimension of literacy practices in a way that foregrounds space, and that considers space as constitutive to human relations and practices. This chapter provides an introduction to spatial literacy research, providing a guide to key theorists, themes, and studies that have shaped historical and new developments in spatial approaches to literacy practice and pedagogy. It begins by reconceptualising socio-spatial approaches to literacy research and defines terms. Intersections with related social theories are examined, with an emphasis on critical approaches and the politics of space. It clarifies the relationship between socio-spatial and socio-cultural paradigms, revisiting the spatial in seminal socio-cultural research. It covers new ground,including networks, flows, and deterritorialisation of literacy practice. The chapter concludes with challenges and recommendations for future language research and educational practice.

Multiliteracies and a new metalanguage for the moving image

Globalised communication in society today is characterised by multimodal forms of meaning making in a context of increased cultural and linguistic diversity, calling for the teaching of multiliteracies. This transformation requires the development of a new metalanguage or language of description for the burgeoning and hybridised variety of text forms associated with information and multimedia technologies. To continue to teach to a narrow band of print-based genres, grammars, and skills is to ignore the reality of textual practices outside of schools. This paper draws from classroom research in a multiliteracies classroom to provide a multimodal analysis of a claymation movie. The significance of the paper is the synthesis of a multimodal metalanguage for teachers and students to describe the features of work in the kineikonic (moving image) mode.

Respiratory monitoring practices during procedural sedation and analgesia in the cardiac catheterisation laboratory could be improved by using capnography to assess ventilation

Background: Procedural sedation and analgesia (PSA) administered by nurses in the cardiac catheterisation laboratory (CCL) is unlikely to yield serious complications. However, the safety of this practice is dependent on timely identification and treatment of depressed respiratory function. Aim: Describe respiratory monitoring in the CCL. Methods: Retrospective medical record audit of adult patients who underwent a procedure in the CCLs of one private hospital in Brisbane during May and June 2010. An electronic database was used to identify subjects and an audit tool ensured data collection was standardised. Results: Nurses administered PSA during 172/473 (37%) procedures including coronary angiographies, percutaneous coronary interventions, electrophysiology studies, radiofrequency ablations, cardiac pacemakers, implantable cardioverter defibrillators, temporary pacing leads and peripheral vascular interventions. Oxygen saturations were recorded during 160/172 (23%) procedures, respiration rate was recorded during 17/172 (10%) procedures, use of oxygen supplementation was recorded during 40/172 (23%) procedures and 13/172 (7.5%; 95% CI=3.59–11.41%) patients experienced oxygen desaturation. Conclusion: Although oxygen saturation was routinely documented, nurses did not regularly record respiration observations. It is likely that surgical draping and the requirement to minimise radiation exposure interfered with nurses’ ability to observe respiration. Capnography could overcome these barriers to respiration assessment as its accurate measurement of exhaled carbon dioxide coupled with the easily interpretable waveform output it produces, which displays a breath-by-breath account of ventilation, enables identification of respiratory depression in real-time. Results of this audit emphasise the need to ascertain the clinical benefits associated with using capnography to assess ventilation during PSA in the CCL.

Patients with terminal cancer who use alternative therapies: their beliefs and practices

This paper examines the extent to which patients who have been diagnosed as having terminal cancer choose to use non-medical therapies. In particular it is concerned with the illness behaviour of patients who are receiving conventional cytotoxic drug and radiation treatments, who also decide to use a wide range of ‘alternative’ medications and therapies. The paper discusses the findings of a study of 152 patients with metastatic cancer that examined the extent to which they used alternative cancer therapies, as well as the beliefs and attitudes they have about their cancer, its treatment, and the practitioners providing that treatment. Four groups of users of alternative therapies, who differ according to their commitment to and the type of therapies they use, were identified. Results of logistic regression analyses indicate that those using alternative therapies were different in range of social attitudes. These differences were primarily their greater reported ‘will to live’ and desire for control over treatment decisions, and the differing beliefs they hold about their disease.

The confidence of speech-language pathology students regarding communicating with people with aphasia

Background Aphasia is an acquired language disorder that can present a significant barrier to patient involvement in healthcare decisions. Speech-language pathologists (SLPs) are viewed as experts in the field of communication. However, many SLP students do not receive practical training in techniques to communicate with people with aphasia (PWA) until they encounter PWA during clinical education placements. Methods This study investigated the confidence and knowledge of SLP students in communicating with PWA prior to clinical placements using a customised questionnaire. Confidence in communicating with people with aphasia was assessed using a 100-point visual analogue scale. Linear, and logistic, regressions were used to examine the association between confidence and age, as well as confidence and course type (graduate-entry masters or undergraduate), respectively. Knowledge of strategies to assist communication with PWA was examined by asking respondents to list specific strategies that could assist communication with PWA. Results SLP students were not confident with the prospect of communicating with PWA; reporting a median 29-points (inter-quartile range 17–47) on the visual analogue confidence scale. Only, four (8.2%) of respondents rated their confidence greater than 55 (out of 100). Regression analyses indicated no relationship existed between confidence and students‘ age (p = 0.31, r-squared = 0.02), or confidence and course type (p = 0.22, pseudo r-squared = 0.03). Students displayed limited knowledge about communication strategies. Thematic analysis of strategies revealed four overarching themes; Physical, Verbal Communication, Visual Information and Environmental Changes. While most students identified potential use of resources (such as images and written information), fewer students identified strategies to alter their verbal communication (such as reduced speech rate). Conclusions SLP students who had received aphasia related theoretical coursework, but not commenced clinical placements with PWA, were not confident in their ability to communicate with PWA. Students may benefit from an educational intervention or curriculum modification to incorporate practical training in effective strategies to communicate with PWA, before they encounter PWA in clinical settings. Ensuring students have confidence and knowledge of potential communication strategies to assist communication with PWA may allow them to focus their learning experiences in more specific clinical domains, such as clinical reasoning, rather than building foundation interpersonal communication skills.