The impact of surgical ward nurses practicing respiratory assessment on positive patient outcomes

Objective: A literature review to examine the incorporation of respiratory assessment into everyday surgical nursing practice; possible barriers to this; and the relationship to patient outcomes. Primary argument: Escalating demands on intensive care beds have led to highly dependent patients being cared for in general surgical ward areas. This change in patient demographics has meant the knowledge and skills required of registered nurses in these areas has expanded exponentially. The literature supported the notion that postoperative monitoring of vital signs should include the fundamental assessment of respiratory rate; depth and rhythm; work of breathing; use of accessory muscles and symmetrical chest movement; as well as auscultation of lung fields using a stethoscope. Early intervention in response to changes in a patient's respiratory health status impacts positively on patient health outcomes. Substantial support exists for the contention that technologically adept nurses who also possess competent respiratory assessment skills make a difference to respiratory care. Conclusions: Sub-clinical respiratory problems have been demonstrated to contribute to adverse events. There is a paucity of research knowledge as to whether respiratory education programs and associated inservice make a difference to nursing clinical practice. Similarly, the implications for associated respiratory educational needs are not well documented, nor has a research base been sufficiently developed to guide nursing practice. Further research has the potential to influence the future role and function of the registered nurse by determining the importance of respiratory education programs on post-operative patient outcomes.

An integrated educational model for continuing nurse education

Aim This paper reports on the development and evaluation of an integrated clinical learning model to inform ongoing education for surgical nurses. The research aim was to evaluate the effectiveness of implementing a Respiratory Skills Update (ReSKU) education program, in the context of organisational utility, on improving surgical nurses' practice in the area of respiratory assessment. Background Continuous development and integration of technological innovations and research in the healthcare environment mandate the need for continuing education for nurses. Despite an increased worldwide emphasis on this, there is scant empirical evidence of program effectiveness. Methods A quasi experimental pre test, post test non–equivalent control group design evaluated the impact of the ReSKU program on surgical nurses' clinical practice. The 2008 study was conducted in a 400 bed regional referral public hospital and was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies. Findings The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group's reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales. Conclusion The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

The influence of online reviews on consumers’ attributions of service quality and control for service standards in hotels

Online travel reviews are emerging as a powerful source of information affecting tourists' pre-purchase evaluation of a hotel organization. This trend has highlighted the need for a greater understanding of the impact of online reviews on consumer attitudes and behaviors. In view of this need, we investigate the influence of online hotel reviews on consumers' attributions of service quality and firms' ability to control service delivery. An experimental design was used to examine the effects of four independent variables: framing; valence; ratings; and target. The results suggest that in reviews evaluating a hotel, remarks related to core services are more likely to induce positive service quality attributions. Recent reviews affect customers' attributions of controllability for service delivery, with negative reviews exerting an unfavorable influence on consumers' perceptions. The findings highlight the importance of managing the core service and the need for managers to act promptly in addressing customer service problems.

Livestock production in a changing climate : adaptation and mitigation research in Australia

Climate change presents a range of challenges for animal agriculture in Australia. Livestock production will be affected by changes in temperature and water availability through impacts on pasture and forage crop quantity and quality, feed-grain production and price, and disease and pest distributions. This paper provides an overview of these impacts and the broader effects on landscape functionality, with a focus on recent research on effects of increasing temperature, changing rainfall patterns, and increased climate variability on animal health, growth, and reproduction, including through heat stress, and potential adaptation strategies. The rate of adoption of adaptation strategies by livestock producers will depend on perceptions of the uncertainty in projected climate and regional-scale impacts and associated risk. However, management changes adopted by farmers in parts of Australia during recent extended drought and associated heatwaves, trends consistent with long-term predicted climate patterns, provide some insights into the capacity for practical adaptation strategies. Animal production systems will also be significantly affected by climate change policy and national targets to address greenhouse gas emissions, since livestock are estimated to contribute ~10% of Australia’s total emissions and 8–11% of global emissions, with additional farm emissions associated with activities such as feed production. More than two-thirds of emissions are attributed to ruminant animals. This paper discusses the challenges and opportunities facing livestock industries in Australia in adapting to and mitigating climate change. It examines the research needed to better define practical options to reduce the emissions intensity of livestock products, enhance adaptation opportunities, and support the continued contribution of animal agriculture to Australia’s economy, environment, and regional communities.

Increasing Food Production Sustainably in a Changing Climate : Understanding the Pressures and Potential

Australian agriculture is faced with the dilemma of increasing food production for a growing domestic and world population while decreasing environmental impacts and supporting the social and economic future of regional communities. The challenge for farmers is compounded by declining rates of productivity growth which have been linked to changes in climate and decreasing investment in agricultural research. The answer must lie in understanding the ecological functionality of landscapes and matching management of agricultural systems and use of natural resources to landscape capacity in a changing climate. A simplified mixed grain and livestock farm case study is used to illustrate the challenges of assessing the potential for shifts in land allocation between commodities to achieve sustainable intensification of nutrition production. This study highlights the risks associated with overly-simplistic solutions and the need for increased investment in research to inform the development of practical strategies for increasing food production in Australian agro-ecosystems while managing the impacts of climate change and addressing climate change mitigation policies.

Brave new green world : consequences of a carbon economy for the conservation of Australian biodiversity

Pricing greenhouse gas emissions is a burgeoning and possibly lucrative financial means for climate change mitigation. Emissions pricing is being used to fund emissions-abatement technologies and to modify land management to improve carbon sequestration and retention. Here we discuss the principal land-management options under existing and realistic future emissions-price legislation in Australia, and examine them with respect to their anticipated direct and indirect effects on biodiversity. The main ways in which emissions price-driven changes to land management can affect biodiversity are through policies and practices for (1) environmental plantings for carbon sequestration, (2) native regrowth, (3) fire management, (4) forestry, (5) agricultural practices (including cropping and grazing), and (6) feral animal control. While most land-management options available to reduce net greenhouse gas emissions offer clear advantages to increase the viability of native biodiversity, we describe several caveats regarding potentially negative outcomes, and outline components that need to be considered if biodiversity is also to benefit from the new carbon economy. Carbon plantings will only have real biodiversity value if they comprise appropriate native tree species and provide suitable habitats and resources for valued fauna. Such plantings also risk severely altering local hydrology and reducing water availability. Management of regrowth post-agricultural abandonment requires setting appropriate baselines and allowing for thinning in certain circumstances, and improvements to forestry rotation lengths would likely increase carbon-retention capacity and biodiversity value. Prescribed burning to reduce the frequency of high-intensity wildfires in northern Australia is being used as a tool to increase carbon retention. Fire management in southern Australia is not readily amenable for maximising carbon storage potential, but will become increasingly important for biodiversity conservation as the climate warms. Carbon price-based modifications to agriculture that would benefit biodiversity include reductions in tillage frequency and livestock densities, reductions in fertiliser use, and retention and regeneration of native shrubs; however, anticipated shifts to exotic perennial grass species such as buffel grass and kikuyu could have net negative implications for native biodiversity. Finally, it is unlikely that major reductions in greenhouse gas emissions arising from feral animal control are possible, even though reduced densities of feral herbivores will benefit Australian biodiversity greatly.

Career implications of multi-layered institutional settings

Project work has grown significantly in volume and recognition in recent decades as projects have ‘become a common form of work organization in all sectors of the economy’ (Lindgren & Packendorff, 2006: 841). This increase in project-based work is just one of the many changes that have been affecting the nature of work, the employment relationship and the associated conceptualization and experience of careers (Baruch, 2004b; Söderlund & Bredin, 2006). A career can be defined as a process of development along a path of work experience and roles in one or more organizations (Baruch & Rosenstein, 1992), and careers involving project-based work take place within multi layered institutional settings. Projects are generally undertaken by small temporary organizations (Ekstedt, Lundin, Söderholm & Wirdenius, 1999; Pettigrew, 2003; Söderlund, 2012) which in turn may form part of larger, permanent entities; involve people drawn from a number of disciplines and organizations; or be formed as partnerships, joint ventures or strategic alliances between two or more organizations (Scott, 2007).

Changing times, persistent paradigms : women and men at work in projects

The Australian economy is currently supported by a resources boom and work opportunities in traditionally male dominated fields of construction and engineering and information technology are at a premium. Yet despite more than 25 years of anti discrimination and equal employment opportunity legislation these industries still employ few women in operational or management roles. This paper investigates the issue of the low representation of women in project management and their different work and career experiences through interviews with male and female project managers.

Task-relationship-self : a framework for understanding service encounter behaviors

Research conducted over past decades has investigated selected service encounter behaviors from either a customer or service provider perspective. However, a comprehensive, dual-perspective framework is lacking. Such a framework is needed to organize knowledge of these behaviors, and thereby provide structure, clarity, and parsimony to the field. This paper describes a three-tier framework of service encounter behavior that was developed by applying grounded theory principles to interviews with customers, service employees, and other stakeholders. These informants described many ways in which they behave when executing service exchanges, dealing with service difficulties, and managing themselves in the process. Using an iterative inductive approach, a conceptual framework was developed in which specific (Tier 1) behaviors were placed within broader (Tier 2) categories, and these lower classification levels were, in turn, interpreted within a conceptual space defined by the (Tier 3) dimensions of task, relationship, and self. This framework was then elaborated and refined by reference to the psychology and marketing literature, a set of 157 audio-recorded service interactions, and an expert panel study. The paper includes comparisons between the framework and those previously proposed, propositions regarding service encounter processes and outcomes, and implications for future research and practice.

Service encounter needs theory : a dyadic, psychosocial approach to understanding service encounters

Interactions between customers and service providers are ubiquitous. Some of these encounters are routine, but many are characterized by conflict and intense emotions. This chapter introduces a new theory, service encounter needs theory (SENT) that aims to elucidate the mechanisms through which service encounter behaviors affect outcomes for customers and employees. Evidence is presented for the preeminence within these encounters of eight psychosocial needs, and propositions are advanced regarding likely antecedents to fulfillment and violation of these needs. Emotional experiences and displays are viewed as important consequences of need fulfillment and violation, as are numerous cognitive, behavioral, and health-related outcomes.

She'll be right mate : inclusivity experiences of men and women working in projects

Occupational segregation is a major source of labour market rigidity and economic inefficiency due to a waste of human resources. Organisations are repeatedly recognised as gendered constructs exhibiting sustained work segregation, income and status inequality, as well as cultural and individual images of gender, and these are perpetuated through their processes, practices and pressures (Acker, 1990). A large percentage of Australia’s workforce is now employed in project-based or project-oriented organisations, leading to the claim that Australia is a project-based economy. For a continued strong performance in this economy, organisations that employ project personnel will need to consider how they address inclusivity and equality in diversity in project based temporary organisations to ensure the supply of high quality project professionals into the future. This paper investigates the inclusion processes experienced and exercised by men and women working in temporary organisations in project situations through a review of reports on the inclusion processes experienced by 60 project managers and project workers in three project based industries in Australia. Results indicate that temporary organisations are not implementing equality and diversity management strategies at the macro level and project workers are accepting this lack of recognition. However inclusivity and equality at the micro level of the team is seen as vital.

Climate variability, climate change and land degradation

Effective response by government and individuals to the risk of land degradation requires an understanding of regional climate variations and the impacts of climate and management on condition and productivity of land and vegetation resources. Analysis of past land degradation and climate variability provides some understanding of vulnerability to current and future climate changes and the information needs for more sustainable management. We describe experience in providing climate risk assessment information for managing for the risk of land degradation in north-eastern Australian arid and semi-arid regions used for extensive grazing. However, we note that information based on historical climate variability, which has been relied on in the past, will now also have to factor in the influence of human-induced climate change. Examples illustrate trends in climate for Australia over the past decade and the impacts on indicators of resource condition. The analysis highlights the benefits of insights into past trends and variability in rainfall and other climate variables based on extended historic databases. This understanding in turn supports more reliable regional climate projections and decision support information for governments and land managers to better manage the risk of land degradation now and in the future.

A regional interpretation of rules and good practice for greenhouse accounting : Northern Australian savanna systems

Land-use change, particularly clearing of forests for agriculture, has contributed significantly to the observed rise in atmospheric carbon dioxide concentration. Concern about the impacts on climate has led to efforts to monitor and curtail the rapid increase in concentrations of carbon dioxide and other greenhouse gases in the atmosphere. Internationally, much of the current focus is on the Kyoto Protocol to the United Nations Framework Convention on Climate Change (UNFCCC). Although electing to not ratify the Protocol, Australia, as a party to the UNFCCC, reports on national greenhouse gas emissions, trends in emissions and abatement measures. In this paper we review the complex accounting rules for human activities affecting greenhouse gas fluxes in the terrestrial biosphere and explore implications and potential opportunities for managing carbon in the savanna ecosystems of northern Australia. Savannas in Australia are managed for grazing as well as for cultural and environmental values against a background of extreme climate variability and disturbance, notably fire. Methane from livestock and non-CO2 emissions from burning are important components of the total greenhouse gas emissions associated with management of savannas. International developments in carbon accounting for the terrestrial biosphere bring a requirement for better attribution of change in carbon stocks and more detailed and spatially explicit data on such characteristics of savanna ecosystems as fire regimes, production and type of fuel for burning, drivers of woody encroachment, rates of woody regrowth, stocking rates and grazing impacts. The benefits of improved biophysical information and of understanding the impacts on ecosystem function of natural factors and management options will extend beyond greenhouse accounting to better land management for multiple objectives.

Calculation of the oxygen isotope discrimination factor for studying plant respiration

Measurement of discrimination against 18O during dark respiration in plants is currently accepted as the only reliable method of estimating the partitioning of electrons between the cytochrome and alternative pathways. In this paper, we review the theory of the technique and its application to a gas-phase system. We extend it to include sampling effects and show that the isotope discrimination factor, D, is calculated as –dln(1 + δ)/dlnO*, where δ is isotopic composition of the substrate oxygen and O*=[O2]/[N2] in a closed chamber containing tissue respiring in the dark. It is not necessary to integrate the expression but, if the integrated form is used, the resultant regression should not be constrained through the origin. This is important since any error in D will have significant effects on the estimation of the flux of electrons through the two pathways.