Improving wound management for residents in Residential Aged Care Facilities: National dissemination and implementation of the evidence based Champions for Skin Integrity Program

Overview The incidence of skin tears, pressure injuries and chronic wounds increases with age [1-4] and therefore is a serious issue for staff and residents in Residential Aged Care Facilities (RACFs). A pilot project funded in Round 2 of the Encouraging Best Practice in Residential Aged Care (EBPRAC) program by the then Australian Government Department of Health and Ageing found that a substantial proportion of residents in aged care facilities experienced pressure injuries, skin tears or chronic wounds. It also found the implementation of the evidence based Champions for Skin Integrity (CSI) model of wound care was successful in significantly decreasing the prevalence and severity of wounds in residents, improving staff skills and knowledge of evidence based wound management, increasing staff confidence with wound management, increasing implementation of evidence based wound management and prevention strategies, and increasing staff awareness of their roles in evidence based wound care at all levels [5]. Importantly, during the project, the project team developed a resource kit on evidence based wound management. Two critical recommendations resulting from the project were that: - The CSI model or a similar strategic approach should be implemented in RACFs to facilitate the uptake of evidence based wound management and prevention - The resource kit on evidence based wound management should be made available to all Residential Aged Care Facilities and interested parties A proposal to disseminate or rollout the CSI model of wound care to all RACFs across Australia was submitted to the department in 2012. The department approved funding from the Aged Care Services Improvement Healthy Ageing Grant (ACSIHAG) at the same time as the Round 3 of the Encouraging Better Practice in Aged Care (EBPAC) program. The dissemination involved two crucial elements: 1. The updating, refining and distribution of a Champions for Skin Integrity Resource Kit, more commonly known as a CSI Resource Kit and 2. The presentation of intensive one day Promoting Healthy Skin “Train the Trainer” workshops in all capital cities and major regional towns across Australia Due to demand, the department agreed to fund a second round of workshops focussing on regional centres and the completion date was extended to accommodate the workshops. Later, the department also decided to host a departmental website for a number of clinical domains, including wound management, so that staff from the residential aged care sector had easy access to a central repository of helpful clinical resource material that could be used for improving the health and wellbeing of their older adults, consumers and carers. CSI Resource Kit Upgrade and Distribution: At the start of the project, a full evidence review was carried out on the material produced during the EBPRAC-CSI Stage 1 project and the relevant evidence based changes were made to the documentation. At the same time participants in the EBPRAC-CSI Stage 1 project were interviewed for advice on how to improve the resource material. Following this the documentation, included in the kit, was sent to independent experts for peer review. When this process was finalised, a learning designer and QUT’s Visual Communications Services were engaged to completely refine and update the design of the resources, and combined resource kit with the goal of keeping the overall size of the kit suitable for bookshelf mounting and the cost at reasonable levels. Both goals were achieved in that the kit is about the same size as a 25 mm A4 binder and costs between $19.00 and $28.00 per kit depending on the size of the print run. The dissemination of the updated CSI resource kit was an outstanding success. Demand for the kits was so great that a second print run of 2,000 kits was arranged on top of the initial print run of 4,000 kits. All RACFs across Australia were issued with a kit, some 2,740 in total. Since the initial distribution another 1,100 requests for kits has been fulfilled as well as 1,619 kits being distributed to participants at the Promoting Healthy Skin workshops. As the project was winding up a final request email was sent to all workshop participants asking if they required additional kits or resources to distribute the remaining kits and resources. This has resulted in requests for 200 additional kits and resources. Feedback from the residential aged care sector and other clinical providers who have interest in wound care has been very positive regarding the utility of the kit, (see Appendix 4). Promoting Healthy Skin Workshops The workshops also exceeded the project team’s initial objective. Our goal of providing workshop training for staff from one in four facilities and 450 participants was exceeded, with overwhelming demand for workshop places resulting in the need to provide a second round of workshops across Australia. At the completion of the second round, 37 workshops had been given, with 1286 participants, representing 835 facilities. A number of strategies were used to promote the workshops ranging from invitations included in the kit, to postcard mail-outs, broadcast emailing to all facilities and aged care networks and to articles and paid advertising in aged care journals. The most effective method, by far, was directly phoning the facilities. This enabled the caller to contact the relevant staff member and enlist their support for the workshop. As this is a labour intensive exercise, it was only used where numbers needed bolstering, with one venue rising from 3 registrants before the calls to 53 registrants after. The workshops were aimed at staff who had the interest and the capability of implementing evidence-based wound management within their facility or organisation. This targeting was successful in that a large proportion (68%) of participants were Registered Nurses, Nurse Managers, Educators or Consultants. Twenty percent were Endorsed Enrolled Nurses with the remaining 12% being made up of Personal Care Workers or Allied Health Professionals. To facilitate long term sustainability, the workshop employed train-the-trainer strategies. Feedback from the EBPRAC-CSI Stage 1 interviews was used in the development of workshop content. In addition, feedback from the workshop conducted at the end of the EBPRAC-CSI Stage 1 project suggested that change management and leadership training should be included in the workshops. The program was trialled in the first workshop conducted in Brisbane and then rolled out across Australia. Participants were asked to complete pre and post workshop surveys at the beginning and end of the workshop to determine how knowledge and confidence improved over the day. Results from the pre and post surveys showed significant improvements in the level of confidence in attendees’ ability to implement evidence based wound management. The results also indicated a significant increase in the level of confidence in ability to implement change within their facility or organisation. This is an important indication that the inclusion of change management/leadership training with clinical instruction can increase staff capacity and confidence in translating evidence into practice. To encourage the transfer of the evidence based content of the workshop into practice, participants were asked to prepare an Action Plan to be followed by a simple one page progress report three months after the workshop. These reports ranged from simple (e.g. skin moisturising to prevent skin tears), to complex implementation plans for introducing the CSI model across the whole organisation. Outcomes described in the project reports included decreased prevalence of skin tears, pressure injuries and chronic wounds, along with increased staff and resident knowledge and resident comfort. As stated above, some organisations prepared large, complex plans to roll out the CSI model across their organisation. These plans included a review of the organisation’s wound care system, policies and procedures, the creation of new processes, the education of staff and clients, uploading education and resource material onto internal electronic platforms and setting up formal review and evaluation processes. The CSI Resources have been enthusiastically sought and incorporated into multiple health care settings, including aged care, acute care, Medicare Local intranets (e.g. Map of Medicine e-pathways), primary health care, community and home care organisations, education providers and New Zealand aged and community health providers. Recommendations: Recommendations for RACFs, aged care and health service providers and government  Skin integrity and the evidence-practice gap in this area should be recognised as a major health issue for health service providers for older adults, with wounds experienced by up to 50% of residents in aged care settings (Edwards et al. 2010). Implementation of evidence based wound care through the Champions for Skin Integrity model in this and the pilot project has demonstrated the prevalence of wounds, wound healing times and wound infections can be halved.  A national program and Centre for Evidence Based Wound Management should be established to: - expand the reach of the model to other aged care facilities and health service providers for older adults - sustain the uptake of models such as the Champions for Skin Integrity (CSI) model - ensure current resources, expertise and training are available for consumers and health care professionals to promote skin integrity for all older adults  Evidence based resources for the CSI program and similar projects should be reviewed and updated every 3 – 4 years as per NH&MRC recommendations  Leadership and change management training is fundamental to increasing staff capacity, at all levels, to promote within-organisation dissemination of skills and knowledge gained from projects providing evidence based training Recommendations for future national dissemination projects  A formal program of opportunities for small groups of like projects to share information and resources, coordinate activities and synergise education programs interactively would benefit future national dissemination projects - Future workshop programs could explore an incentive program to optimise attendance and reduce ‘no shows’ - Future projects should build in the capacity and funding for increased follow-up with workshop attendees, to explore the reasons behind those who are unable to translate workshop learnings into the workplace and identify factors to address these barriers.

Uncertain species distribution: From interpolation to extrapolation

Species distribution models (SDMs) are considered to exemplify Pattern rather than Process based models of a species' response to its environment. Hence when used to map species distribution, the purpose of SDMs can be viewed as interpolation, since species response is measured at a few sites in the study region, and the aim is to interpolate species response at intermediate sites. Increasingly, however, SDMs are also being used to also extrapolate species-environment relationships beyond the limits of the study region as represented by the training data. Regardless of whether SDMs are to be used for interpolation or extrapolation, the debate over how to implement SDMs focusses on evaluating the quality of the SDM, both ecologically and mathematically. This paper proposes a framework that includes useful tools previously employed to address uncertainty in habitat modelling. Together with existing frameworks for addressing uncertainty more generally when modelling, we then outline how these existing tools help inform development of a broader framework for addressing uncertainty, specifically when building habitat models. As discussed earlier we focus on extrapolation rather than interpolation, where the emphasis on predictive performance is diluted by the concerns for robustness and ecological relevance. We are cognisant of the dangers of excessively propagating uncertainty. Thus, although the framework provides a smorgasbord of approaches, it is intended that the exact menu selected for a particular application, is small in size and targets the most important sources of uncertainty. We conclude with some guidance on a strategic approach to identifying these important sources of uncertainty. Whilst various aspects of uncertainty in SDMs have previously been addressed, either as the main aim of a study or as a necessary element of constructing SDMs, this is the first paper to provide a more holistic view.

Defining green road infrastructure projects—A critical review

Green infrastructure is considered as a strategic approach to address the ecological and social impacts of urban sprawl. The main elements of green infrastructure have been well established and include a series of multifunctional ecological systems, such as green urban space, green road infrastructure and the links between these systems. However, it should be noted that the elements of green road infrastructure have only been briefly mentioned in isolated life cycle stages, e.g. design, procurement, construction, maintenance and operation. The definition of green road infrastructure and the elements in green road infrastructure projects remain largely unknown. To explore the elements in green road infrastructure, a critical review was adopted. As the development of green road infrastructure projects is guided by rating systems, a comparison of three major green roads rating systems, including GreenroadsTM, EnvisionTM and Infrastructure Sustainability Rating Tool—IS, was conducted. The comparison reveals that green roads can be defined as road projects that have superior performance in economic, social and environmental sustainability. The sustainability features in green roads mainly include environmental sustainability, social sustainability, economic sustainability, quality, pavement technology and innovation. The results will contribute to an increased understanding of green roads and will be useful to improve the performance of road projects on these sustainability features.

Contributing to computing services to benchmarking asset management knowledge management

Asset management has broadened from a focus on maintenance management to whole of life cycle asset management requiring a suite of new competencies from asset procurement to management and disposal. Well developed skills and competencies as well as practical experience are a prerequisite to maintain capability, to manage demand as well to plan and set priorities and ensure on-going asset sustainability. This paper has as its focus to establish critical understandings of data, information and knowledge for asset management along with the way in which benchmarking these attributes through computer-aided design may aid a strategic approach to asset management. The paper provides suggestions to improve sharing, integration and creation of asset-related knowledge through the application of codification and personalization approaches.

Pedagogical tools designed to promote engagement and active learning in the biomedical sciences and allied health disciplines

Perceiving students, science students especially, as mere consumers of facts and information belies the importance of a need to engage them with the principles underlying those facts and is counter-intuitive to the facilitation of knowledge and understanding. Traditional didactic lecture approaches need a re-think if student classroom engagement and active learning are to be valued over fact memorisation and fact recall. In our undergraduate biomedical science programs across Years 1, 2 and 3 in the Faculty of Health at QUT, we have developed an authentic learning model with an embedded suite of pedagogical strategies that foster classroom engagement and allow for active learning in the sub-discipline area of medical bacteriology. The suite of pedagogical tools we have developed have been designed to enable their translation, with appropriate fine-tuning, to most biomedical and allied health discipline teaching and learning contexts. Indeed, aspects of the pedagogy have been successfully translated to the nursing microbiology study stream at QUT. The aims underpinning the pedagogy are for our students to: (1) Connect scientific theory with scientific practice in a more direct and authentic way, (2) Construct factual knowledge and facilitate a deeper understanding, and (3) Develop and refine their higher order flexible thinking and problem solving skills, both semi-independently and independently. The mindset and role of the teaching staff is critical to this approach since for the strategy to be successful tertiary teachers need to abandon traditional instructional modalities based on one-way information delivery. Face-to-face classroom interactions between students and lecturer enable realisation of pedagogical aims (1), (2) and (3). The strategy we have adopted encourages teachers to view themselves more as expert guides in what is very much a student-focused process of scientific exploration and learning. Specific pedagogical strategies embedded in the authentic learning model we have developed include: (i) interactive lecture-tutorial hybrids or lectorials featuring teacher role-plays as well as class-level question-and-answer sessions, (ii) inclusion of “dry” laboratory activities during lectorials to prepare students for the wet laboratory to follow, (iii) real-world problem-solving exercises conducted during both lectorials and wet laboratory sessions, and (iv) designing class activities and formative assessments that probe a student’s higher order flexible thinking skills. Flexible thinking in this context encompasses analytical, critical, deductive, scientific and professional thinking modes. The strategic approach outlined above is designed to provide multiple opportunities for students to apply principles flexibly according to a given situation or context, to adapt methods of inquiry strategically, to go beyond mechanical application of formulaic approaches, and to as much as possible self-appraise their own thinking and problem solving. The pedagogical tools have been developed within both workplace (real world) and theoretical frameworks. The philosophical core of the pedagogy is a coherent pathway of teaching and learning which we, and many of our students, believe is more conducive to student engagement and active learning in the classroom. Qualitative and quantitative data derived from online and hardcopy evaluations, solicited and unsolicited student and graduate feedback, anecdotal evidence as well as peer review indicate that: (i) our students are engaging with the pedagogy, (ii) a constructivist, authentic-learning approach promotes active learning, and (iii) students are better prepared for workplace transition.

Potential Distribution and Risk Assessment of an Invasive Plant Species: A Case Study of Hymenachne amplexicaulis in Australia

Given the limited resources available for weed management, a strategic approach is required to give the best bang for your buck. The current study incorporates: (1) a model ensemble approach to identify areas of uncertainty and commonality regarding a species invasive potential, (2) current distribution of the invaded species, and (3) connectivity of systems to identify target regions and focus efforts for more effective management. Uncertainty in the prediction of suitable habitat for H. amplexicaulis (study species) in Australia was addressed in an ensemble-forecasting approach to compare distributional scenarios from four models (CLIMATCH; CLIMEX; boosted regression trees [BRT]; maximum entropy [Maxent]). Models were built using subsets of occurrence and environmental data. Catchment risk was determined through incorporating habitat suitability, the current abundance and distribution of H. amplexicaulis, and catchment connectivity. Our results indicate geographic differences between predictions of different approaches. Despite these differences a number of catchments in northern, central, and southern Australia were identified as high risk of invasion or further spread by all models suggesting they should be given priority for the management of H. amplexicaulis. The study also highlighted the utility of ensemble approaches in indentifying areas of uncertainty and commonality regarding the species invasive potential.

Case study: Reaping the benefits of reliable systems and flexible support

Case study on how Chichester College is taking a strategic approach to improving the student experience through effective use of technology.

Case study: Making it happen, embedding digital technologies in curriculum activities

Case study on how South Eastern Regional College are taking a strategic approach to managing and developing digital technologies to enhance the student experience.

Vocational education for the development of knowledge system in fisheries sector

The paper aims to give the concept and functional approach of knowledge system with reference to the fisheries sector. The background and strategies to develop knowledge workers by translating the concept of knowledge system are presented. The job opportunities given in the paper strengthen the need of the development of knowledge workers through vocational education and training. The Vocational Education Programme in the backdrop can be effective both in the formal system of education through different models suggested and through the non-formal system. The modular courses varying from 50 hours and 2-3 weeks to 6 months or one year can be introduced in the formal system as pre-vocational modules (50-h duration) in IX-X classes in vocational institutions, and the non-governmental organizations/Krishi Vigyan Kendras/Indian Council of Agricultural Research may offer occupation-based modules (2-3 weeks to 6 months). The strategic approach for the development of knowledge system highlighting various issues is also suggested.

The Arab Spring as a Test of post-Lisbon Capabilities and Strategies of the European Union in North Africa

This study aims to present the conditions related to the European Union’s involvement in the Arab Spring, as well as examine the extent of this capability-based involvement in the first months of 2011 against the background of competence disputes between institutions and inter-governmental contentions. These considerations will be the basis for conclusions on the theoretical and practical viability of the European Union’s action in the region of North Africa, in terms of both interests defined in Brussels and representation of a jointly agreed position and undertaking practical actions in the international arena. These assumptions can facilitate a new perspective for the EU’s strategic approach framework in the region of North Africa.

Uwarunkowania reorientacji polityki Unii Europejskiej wobec Afryki Północnej po roku 2011

Celem artykułu jest ukazanie uwarunkowań reorientacji polityki Unii wobec regionu Afryki Północnej po roku 2011, w związku z jej zaangażowaniem podczas ‘arabskiej wiosny’, a także analiza zakresu nowego podejścia w odniesieniu do praktycznych możliwości wdrażania unijnych instrumentów polityk. Powyższe rozważania pozwolą na przedstawienie wniosków dotyczących dalszego zaangażowania Unii Europejskiej w regionie Afryki Północnej i budowy nowych ram podejścia strategicznego UE w tym regionie, zarówno na płaszczyźnie ustalania interesów na arenie brukselskiej, jak i przedstawienia wypracowanego stanowiska i uruchomienia działań na arenie międzynarodowej.

Mapping NGO Competency to Reduce Human Vulnerability in Post-disaster Communities: Comparing Strategies in Sri Lanka and Bangladesh

Natural hazards trigger disasters, the scale of which is largely determined by vulnerability. Developing countries suffer the most from disasters due to various conditions of vulnerability which exist and there is an opportunity after disasters to take mitigative action. NGOs implementing post-disaster rehabilitation projects must be able to address the issues causing communities to live at risk of disaster and therefore must build dynamic capacity, capabilities and competencies, enabling them to operate in unstable environments. This research is built upon a theoretical framework of dynamic competency established by combining elements of disaster management, strategic management and project management theory. A number of NGOs which have implemented reconstruction and rehabilitation projects both in Sri Lanka following the Asian Tsunami and Bangladesh following Cyclone Sidr are being investigated in great depth using a causal mapping procedure. ‘Event’ specific maps have been developed for each organization in each disaster. This data will be analysed with a view to discovering the strategies which lead to vulnerability reduction in post-disaster communities and the competencies that NGOs must possess in order to achieve favourable outcomes. It is hypothesized that by building organizational capacity, capabilities and competencies to be dynamic in nature, while focusing on a more emergent strategic approach, with emphasis on adaptive capability and innovation, NGOs will be better equipped to contribute to sustainable community development through reconstruction. We believe that through this study it will be possible to glean a new understanding of social processes that emerge within community rehabilitation projects.

A systematic review of systematic reviews to improve maternal mental health and well-being

Objective: to identify non-invasive interventions in the perinatal period that could enable midwives to offer effective support to women within the area of maternal mental health and well-being.

Methods: a total of 9 databases were searched: MEDLINE, PubMed, EBSCO (CINAHL/British Nursing Index), MIDIRS Online Database, Web of Science, The Cochrane library, CRD (NHS EED/DARE/HTA), Joanne Briggs Institute and EconLit. A systematic search strategy was formulated using key MeSH terms and related text words for midwifery, study aim, study design and mental health. Inclusion criteria were articles published from 1999 onwards, English language publications and articles originating from economically developed countries, indicated by membership of the Organisation for Economic Co-operation and Development (OECD). Data were independently extracted using a data collection form, which recorded data on the number of papers reviewed, time frame of the review, objectives, key findings and recommendations. Summary data tables were set up outlining key data for each study and findings were organised into related groups. The methodological quality of the reviews was assessed based on predefined quality assessment criteria for reviews.

Findings: 32 reviews were identified as examining interventions that could be used or co-ordinated by midwives in relation to some aspect of maternal mental health and well-being from the antenatal to the postnatal period and met the inclusion criteria. The review highlighted that based on current systematic review evidence it would be premature to consider introducing any of the identified interventions into midwifery training or practice. However there were a number of examples of possible interventions worthy of further research including midwifery led models of care in the prevention of postpartum depression, psychological and psychosocial interventions for treating postpartum depression and facilitation/co-ordination of parent-training programmes. No reviews were identified that supported a specific midwifery role in maternal mental health and well-being in pregnancy, and yet, this is the point of most intensive contact.

Key conclusions and implications for practice: This systematic review of systematic reviews provides a valuable overview of the current strengths and gaps in relation to maternal mental health interventions in the perinatal period. While there was little evidence identified to inform the current role of midwives in maternal mental health, the review provides the opportunity to reflect on what is achievable by midwives now and in the future and the need for high quality randomised controlled trials to inform a strategic approach to promoting maternal mental health in midwifery.

Can Future Managers and Business Executives be Influenced to Behave more Ethically in the Workplace? The Impact of Approaches to Learning on Business Students’ Cheating Behavior

This study considers the potential for influencing business students to become ethical managers by directing their undergraduate learning environment. In particular, the relationship between business students’ academic cheating, as a predictor of workplace ethical behavior, and their approaches to learning is explored. The three approaches to learning identified from the students’ approaches to learning literature are deep approach, represented by an intrinsic interest in and a desire to understand the subject, surface approach, characterized by rote learning and memorization without understanding, and strategic approach, associated with competitive students whose motivation is the achievement of good grades by adopting either a surface or deep approach. Consistent with the hypothesized theoretical model, structural equation modeling revealed that the surface approach is associated with higher levels of cheating, while the deep approach is related to lower levels. The strategic approach was also associated with less cheating and had a statistically stronger influence than the deep approach. Further, a significantly positive relationship reported between deep and strategic approaches suggests that cheating is reduced when deep and strategic approaches are paired. These findings suggest that future managers and business executives can be influenced to behave more ethically in the workplace by directing their learning approaches. It is hoped that the evidence presented may encourage those involved in the design of business programs to implement educational strategies which optimize students’ approaches to learning towards deep and strategic characteristics, thereby equipping tomorrow’s managers and business executives with skills to recognize and respond appropriately to workplace ethical dilemmas.

Abordagens à aprendizagem em estudantes do ensino superior

Resumo - As investigações realizadas no âmbito das abordagens à aprendizagem demonstram que existem diferenças significativas entre a abordagem superficial, profunda e estratégica. As duas primeiras descrevem formas de comprometimento dos alunos com as tarefas académicas e a diferença entre ambas reside, fundamentalmente, na intenção do estudante em alcançar a compreensão pessoal ou apenas recorrer a processos de memorização mecânica. A terceira caracteriza essencialmente a atitude face ao contexto escolar com vista à obtenção dos melhores resultados (Entwistle, 2009; Lee, Johanson & Tsai, 2008). O estudo que se apresenta foi realizado com 562 estudantes de 1º ano de vários cursos de licenciatura da Universidade de Évora após avaliação do primeiro semestre. Os dados que se apresentam reportam-se às abordagens à aprendizagem e ao nível de satisfação dos estudantes tendo em conta a área científica do curso frequentado, o curso e o sucesso académico. De um modo geral encontramos que os estudantes utilizam, predominante, a abordagem profunda e a estratégica para aprender e que existe relação entre os resultados na avaliação e o nível de satisfação dos estudantes. Abstract - The investigations carried about approaches to learning demonstrate that significant differences exist between the surface, deep and strategic approaches. The first two describe the students' engagement with academic tasks. The difference between them is connected to the student's intention: achieve personal understanding or just memorization processes. The third approach characterizes attitude towards school context with a view to obtaining the best results (Entwistle, 2009; Lee, Tsai & Johanson, 2008). The study that has been conducted with 562 students from 1st year of various degree courses at the University of Évora after evaluation of the first semester. The data presented relate to approaches to learning and the level of enjoyment about scientific area, course and academic success. In general we found that students use, predominantly, the deep and strategic approach to learning and we find also a relationship between academic results and student’s enjoyment.