Focusing on patients : differences between the practice of expert and non-expert nephrology nurses

Specialisation in nursing enables a nurse to focus, in much greater depth, on the requisite knowledge and skills for providing patients with the best possible care. Nephrology nursing is one such area where specialisation has evolved. The characteristic focus of practice emerged as an important feature during a study into the process of expertise acquisition in nephrology nursing practice. Using grounded theory methodology, this study involved 6 non-expert and 11 expert nurses and took place in one renal unit in New South Wales. Nephrology nursing practice was observed for 103 hours, and this was immediately followed by semi-structured interviews. The characteristic of focus was conceptualised as the nurses' centre of attention or concentration while they were undertaking nursing activities. Focus ranged from inexperienced non-expert nurses concentrating predominantly on the immediate task at hand, experienced non-expert nurses who focussed on the medium term to expert nurses who viewed actions (and their possible consequences) more broadly and in the longer term. Of significance to nursing, is how nephrology nurses alter their focus of practice as they acquire and exercise their developing expertise in this specialty.

CDA and values : interdisciplinarity as a critical turn

From their very outset, the disciplines of social science have claimed a need for interdisciplinarity. Proponents of new disciplines have also claimed the whole of human activity as their domain, whilst simultaneously emphasising the need for increased specialisation. Critical social analysis attempts to repair the flaws of specialisation. In this chapter, I argue that the trend towards academic specialisation in social science is most usefully viewed from the perspective of evaluative meaning, and that each new discipline, in emphasising one aspect of a broken conception of humanity, necessarily emphasises one aspect of an already broken conception of value. Critical discourse analysis, qua critical social analysis, may therefore benefit by firstly proceeding from the perspective of evaluative meaning to understand the dynamics of social change and overcome the challenges posed by centuries of intensive specialisation in social science.

APS grant enhances educational psychology’s impact in Bangladesh

The APS Grant for Intercultural and/or International Projects of up to $10,000 supports innovative projects that have an intercultural and/or international focus, particularly in countries where psychology is an emerging discipline. Associate Professors Linda Gilmore MAPS and Marilyn Campbell MAPS from Queensland University of Technology were awarded the APS Grant in 2010-11. Their project aimed to promote and advance the profession of psychology in Bangladesh by supporting the newly introduced specialisation of educational psychology. With a population of 159 million in a country only twice the size of Tasmania, Bangladesh is one of the poorest and most densely populated countries in the world. Yet at the time this project commenced, there was only one school psychologist in the entire country. Linda Gilmore shared her experiences and insights about the project with InPsych.

Designing the future in wound care : the role of the nurse practitioner

The nurse practitioner is emerging as a new level and type of health care. Increasing specialisation and advanced educational opportunities in nursing and the inequality in access to health care for sectors of the community have established the conditions under which the nurse practitioner movement has strengthened both nationally and internationally. The boundaries of responsibility for nurses are changing, not only because of increased demands but also because nurses have demonstrated their competence in varied extended and expanded practice roles. The nurse practitioner role reflects the continuing development of the nursing profession and substantially extends the career path for clinical nurses. This paper describes an aspect of a large-scale investigation into the feasibility of the role of the nurse practitioner in the Australian Capital Territory (ACT) health care system. The paper reports on the trial of practice for a wound care nurse practitioner model in a tertiary institution. In the trial the wound care nurse practitioner worked in an extended practice role for 10 months. The nurse practitioner practice was supported, monitored and mentored by a clinical support team. Data were collected relating to a range of outcomes including definition of the scope of practice for the model, description of patient demographics and outcomes and the efficacy of the nurse practitioner service. The findings informed the development of clinical protocols that define the scope of practice and the parameters of the wound care nurse practitioner model and provided information on the efficacy of this model of health care for the tertiary care environment. The findings further suggest that this model brings expert wound care and case management to an at-risk patient population. Recommendations are made relating to ongoing research into the role of the wound care nurse practitioner model in the ACT health care system.

The specialist nurse : an investigation of the common and distinct aspects of practice

Over the past decade the discipline of nursing has been reviewing its practice, especially in relation to specialty areas. There has been an appreciation by nursing leaders that specialisation brings with it concerns related to a disuniting effect on the discipline and a fragmentation of nursing's traditional generalist practice. Accompanying these concerns is a debate over what is a specialty and how to define a specialist. This qualitative study drew upon a constructivist methodology, to explore how nurses, working in specialty areas, define and give meaning to their practice. Three groups of nurses (n=20) from the specialty of critical care were interviewed using a focus group technique. The data were analysed to build constructions of specialty practice. A distinct and qualitative difference was recognised in the practice behaviours of nurses working in the specialty area. The qualitatively different practice behaviours have been identified as ‘nursing-in-a-specialty’ and ‘specialist nurse’. Two constructions emerged to differentiate the skill behaviours, these were ‘practice’ and ‘knowledge’. The specialist nurse practices were based on two distinct types of practice, that of ‘discretion’ and ‘incorporation’. ‘Knowledge’ was constructed as a synthesis of propositional and practice knowledge.

Educating for digital futures : what the learning strategies of digital content professionals can teach higher education

Beginning in the second half of the 20th century, ICTs transformed many societies from industrial societies in which manufacturing was the central focus, into knowledge societies in which dealing effectively with data and information has become a central element of work (Anderson, 2008). To meet the needs of the knowledge society, universities must reinvent their structures and processes, their curricula and pedagogic practices. In addition to this, of course higher education is itself subject to the sweeping influence of ICTs. But what might effective higher education look like in the 21st century? In designing higher education systems and learning experiences which are responsive to the learning needs of the future and exploit the possibilities offered by ICTs, we can learn much from the existing professional development strategies of people who are already successful in 21st century fields, such as digital media. In this study, I ask: (1) what are the learning challenges faced by digital media professionals in the 21st century? (2) what are the various roles of formal and informal education in their professional learning strategies at present? (3) how do they prefer to acquire needed capabilities? In-depth interviews were undertaken with successful Australian digital media professionals working in micro businesses and SMEs to answer these questions. The strongest thematic grouping that emerged from the interviews related to the need for continual learning and relearning because of the sheer rate of change in the digital media industries. Four dialectical relationships became apparent from the interviewees’ commentaries around the learning imperatives arising out of the immense and continual changes occurring in the digital content industries: (1) currency vs best practice (2) diversification vs specialisation of products and services (3) creative outputs vs commercial outcomes (4) more learning opportunities vs less opportunity to learn. These findings point to the importance of ‘learning how to learn’ as a 21st century capability. The interviewees were ambivalent about university courses as preparation for professional life in their fields. Higher education was described by several interviewees as having relatively little value-add beyond what one described as “really expensive credentialling services.” For all interviewees in this study, informal learning strategies were the preferred methods of acquiring the majority of knowledge and skills, both for ongoing and initial professional development. Informal learning has no ‘curriculum’ per se, and tends to be opportunistic, unstructured, pedagogically agile and far more self-directed than formal learning (Eraut, 2004). In an industry impacted by constant change, informal learning is clearly both essential and ubiquitous. Inspired by the professional development strategies of the digital media professionals in this study, I propose a 21st century model of the university as a broad, open learning ecology, which also includes industry, professionals, users, and university researchers. If created and managed appropriately, the university learning network becomes the conduit and knowledge integrator for the latest research and industry trends, which students and professionals alike can access as needed.

The IKBALS project: multi-modal reasoning in legal knowledge based systems

In attempting to build intelligent litigation support tools, we have moved beyond first generation, production rule legal expert systems. Our work integrates rule based and case based reasoning with intelligent information retrieval. When using the case based reasoning methodology, or in our case the specialisation of case based retrieval, we need to be aware of how to retrieve relevant experience. Our research, in the legal domain, specifies an approach to the retrieval problem which relies heavily on an extended object oriented/rule based system architecture that is supplemented with causal background information. We use a distributed agent architecture to help support the reasoning process of lawyers. Our approach to integrating rule based reasoning, case based reasoning and case based retrieval is contrasted to the CABARET and PROLEXS architectures which rely on a centralised blackboard architecture. We discuss in detail how our various cooperating agents interact, and provide examples of the system at work. The IKBALS system uses a specialised induction algorithm to induce rules from cases. These rules are then used as indices during the case based retrieval process. Because we aim to build legal support tools which can be modified to suit various domains rather than single purpose legal expert systems, we focus on principles behind developing legal knowledge based systems. The original domain chosen was theAccident Compensation Act 1989 (Victoria, Australia), which relates to the provision of benefits for employees injured at work. For various reasons, which are indicated in the paper, we changed our domain to that ofCredit Act 1984 (Victoria, Australia). This Act regulates the provision of loans by financial institutions. The rule based part of our system which provides advice on the Credit Act has been commercially developed in conjunction with a legal firm. We indicate how this work has lead to the development of a methodology for constructing rule based legal knowledge based systems. We explain the process of integrating this existing commercial rule based system with the case base reasoning and retrieval architecture.

Managing growth and entry strategies across borders

Should the firm move successfully into a growth or expansion phase the owner manager will be required to increase the scale and scope of its operations. Part of this expansion will involve hiring additional employees, and increasing the overall complexity of the firm's activities. It is likely that the need for greater levels of professional management will be required to operate the firm, along with the need for enhanced planning and the introduction of systems to support the new levels of complexity. The transition from a small, owner-managed firm to a large systems-managed business will require the development of a team-based management approach with greater specialisation within the management team. Corporate governance is also likely to change as the growth cycle takes place. As it grows, the business will become more formalised in its accounting, management and other systems. The need for greater quantities of capital is likely to lead the business towards equity finance. As new equity partner are taken into the company the original owner managers may find their level of control diminished. The larger the firm becomes the more likely its management structure will become decentralised with greater separation between the owner and the firm in terms of operational and financial matters.

Interrogating Creative Theory and Creative Work: Inside the Games Studio

The expansion of creative and cultural industries has provided a rich source for theoretical claims and commentary. Much of this reproduces and extends the idea that autonomy is the defining feature of both enterprises and workers. Drawing on evidence from research into Australian development studios in the global digital games industry, the article interrogates claims concerning autonomy and related issues of insecurity and intensity, skill and specialisation, work–play boundaries, identity and attachments. In seeking to reconnect changes in creative labour to the wider production environment and political economy, an argument is advanced that autonomy is deeply contextual and contested as a dimension of the processes of capturing value for firms and workers.

The transition to palliative care: A critical exploration in the context of metastatic melanoma

This research explored the transition to palliative care process through critical analysis of the experiences of patients diagnosed with metastatic melanoma, family carers and health professionals. The outcomes depict a complex intersection between acute care services and palliative care where the discipline of palliative care struggled to position itself within a highly specialised health system. The findings indicate uncertainty around scopes of practice with ambiguity and tension around the transition to palliative care. The research thus argues for stronger and more coherent partnerships and a critical and interdisciplinary conversation about the positioning of palliative care in the acute care sector.

Someone else's boom but always our bust: Australia as a derivative economy, implications for regions

This paper examines the socio-economic impact of mineral and agricultural resource extraction on local communities and explores policy options for addressing them. An emphasis on the marketisation of services together with tight fiscal control has reinforced decline in many country communities in Australia and elsewhere. However, the introduction by the European Union of Regional Policy which emphasises ‘smart specialisation’ can enhance greatly the capacity of local people to generate decent livelihoods. For this to have real effect, the innovative state has to enable partnerships between communities, researchers and industry. For countries like Australia, this would be a substantive policy shift.

Analysis on conservation of disulphide bonds and their structural features in homologous protein domain families

Background: Disulphide bridges are well known to play key roles in stability, folding and functions of proteins. Introduction or deletion of disulphides by site-directed mutagenesis have produced varying effects on stability and folding depending upon the protein and location of disulphide in the 3-D structure. Given the lack of complete understanding it is worthwhile to learn from an analysis of extent of conservation of disulphides in homologous proteins. We have also addressed the question of what structural interactions replaces a disulphide in a homologue in another homologue. Results: Using a dataset involving 34,752 pairwise comparisons of homologous protein domains corresponding to 300 protein domain families of known 3-D structures, we provide a comprehensive analysis of extent of conservation of disulphide bridges and their structural features. We report that only 54% of all the disulphide bonds compared between the homologous pairs are conserved, even if, a small fraction of the non-conserved disulphides do include cytoplasmic proteins. Also, only about one fourth of the distinct disulphides are conserved in all the members in protein families. We note that while conservation of disulphide is common in many families, disulphide bond mutations are quite prevalent. Interestingly, we note that there is no clear relationship between sequence identity between two homologous proteins and disulphide bond conservation. Our analysis on structural features at the sites where cysteines forming disulphide in one homologue are replaced by non-Cys residues show that the elimination of a disulphide in a homologue need not always result in stabilizing interactions between equivalent residues. Conclusion: We observe that in the homologous proteins, disulphide bonds are conserved only to a modest extent. Very interestingly, we note that extent of conservation of disulphide in homologous proteins is unrelated to the overall sequence identity between homologues. The non-conserved disulphides are often associated with variable structural features that were recruited to be associated with differentiation or specialisation of protein function.

Death in the Bolivian High Plateau : Burials and Tiwanaku Society

My Ph.D. dissertation presents a multi-disciplinary analysis of the mortuary practices of the Tiwanaku culture of the Bolivian high plateau, situated at an altitude of c. 3800 m above sea level. The Tiwanaku State (c. AD 500-1150) was one of the most important pre-Inca civilisations of the South Central Andes. The book begins with a brief introductory chapter. In chapter 2 I discuss methodological and theoretical developments in archaeological mortuary studies from the late 1960s until the turn of the millennium. I am especially interested in the issue how archaeological burial data can be used to draw inferences on the social structure of prehistoric societies. Chapter 3 deals with the early historic sources written in the 16th and 17th centuries, following the Spanish Conquest of the Incas. In particular, I review information on how the Incas manifested status differences between and within social classes and what kinds of burial treatments they applied. In chapter 4 I compare the Inca case with 20th century ethnographic data on the Aymara Indians of the Bolivian high plateau. Even if Christianity has affected virtually every level of Aymara religion, surprisingly many traditional features can still be observed in present day Aymara mortuary ceremonies. The archaeological part of my book begins with chapter 5, which is an introduction into Tiwanaku archaeology. In the next chapter, I present an overview of previously reported Tiwanaku cemeteries and burials. Chapter 7 deals with my own excavations at the Late Tiwanaku/early post-Tiwanaku cemetery site of Tiraska, located on the south-eastern shore of Lake Titicaca. During the 1998, 2002, and 2003 field seasons, a total of 32 burials were investigated at Tiraska. The great majority of these were subterranean stone-lined tombs, each containing the skeletal remains of 1 individual and 1-2 ceramic vessels. Nine burials have been radiocarbon dated, the dates in question indicating that the cemetery was in use from the 10th until the 13th century AD. In chapter 8 I point out that considerable regional and/or ethnic differences can be noted between studied Tiwanaku cemetery sites. Because of the mentioned differences, and a general lack of securely dated burial contexts, I feel that at present we can do no better than to classify most studied Tiwanaku burials into three broad categories: (1) elite and/or priests, (2) "commoners", and (3) sacrificial victims and/or slaves and/or prisoners of war. On the basis of such indicators as monumental architecture and occupational specialisation we would expect to find considerable status-related differences in tomb size, grave goods, etc. among the Tiwanaku. Interestingly, however, such variation is rather modest, and the Tiwanaku seem to have been a lot less interested in expending considerable labour and resources in burial facilities than their pre-Columbian contemporaries of many parts of the Central Andes.

Podiatry scope of practice: The role of gender in identification as a specialist

Background Ensuring efficient and effective delivery of health care to an aging population has been a major driver for a review of the health workforce in Australia. As part of this review a new National Registration and Accreditation Scheme (NRAS) has evolved with one goal being to improve workforce flexibility. With increased flexibility there have been discussions about the role specialist scopes of practice plays. This study explored the role of gender and other work related characteristics in relation to contemporary scope of podiatry practice and specialisation in Australia. Methods A cross sectional survey was administered through an on-line survey tool on behalf of the Australasian Podiatry Council. Descriptive data was collected over a three-week period. Queensland University of Technology Human Research Ethics approval was sought and confirmed exemption from review, exemption number 1400000791. Results Of the podiatrists participating in this survey (n=218), they were predominately female (66%), early career (34%, 0-9 years) and work in private practices (78%) in multi-podiatrists centres (41%). Relationship between clinical activities performed and “self-perception” of performing a “specialist role” was significant for practitioners who undertook treatment of specific patient groups. The largest area of interest was biomechanics (n=65), followed closely by diabetes (n=61), a third area identified was paediatrics (n=26). Self-perception of specialist status was compared with gender, years of experience, location, primary work environment and clinical practice. When practitioners are asked to categorise themselves to be either “generalist” or “specialist/ generalist with a special interest” podiatrist, male gender was identified as being the only factor which would predict perception of status; 64% males identified as specialist, as opposed to 49% of female survey respondents (Chi square, df = 1, P = 0.044). Self-perception of specialist status was not explained by years of experience, location, working in rural versus urban environment, state worked in, or part-time/full-time work status. Conclusions In conclusion; gender, work environment plus area of interest form a complex relationship, which appear to influence both perception and reality of service provision. Incorporation of specialisation activity (surgical podiatry along with endorsement for use of scheduled medicines) will have lasting impact on the scope of the podiatry profession in Australia. To meet community expectation and maintain high standards, the addition of new subspecialties may be indicated.

Tiedettä Pohjantähden alla : Pohjoisen tutkimus ja Ruotsin tiedeseurojen suhteet Ranskaan 1700-luvulla

In the eighteenth century, the birth of scientific societies in Europe created a new framework for scientific cooperation. Through a new contextualist study of the contacts between the first scientific societies in Sweden and the most important science academy in Europe at the time, l Académie des Sciences in Paris, this dissertation aims to shed light on the role taken by the Swedish learned men in the new networks. It seeks to show that the academy model was related to a new idea of specialisation in science. In the course of the eighteenth century, it is argued, the study of the northern phenomena and regions offered the Swedes an important field of speciality with regard to their foreign colleagues. Although historical studies have often underlined the economic, practical undertone of eighteenth-century Swedish science, participation in fashionable scientific pursuits had also become an important scene for representation. However, the views prevailing in Europe tied civilisation and learning closely to the sunnier, southern climates, which had lead to the difficulty of portraying Sweden as a learned country. The image of the scientific North, as well as the Swedish strategies to polish the image of the North as a place for science, are analysed as seen from France. While sixteenth-century historians had preferred to put down the effects of the cold and claim a similarity of northern conditions to the others, the scientific exchange between Swedish and French researchers shows a new tendency to underline the difference of the North and its harsh climate. An explanation is sought by analysing how information about northern phenomena was used in France. In the European academies, new empirical methods had lead to a need for direct observations on different phenomena and circumstances. Rather than curiosities or objects for exoticism, the eighteenth-century depictions of the northern periphery tell about an emerging interest in the most extreme, and often most telling, examples of the workings of the invariable laws of nature. Whereas the idea of accumulating knowledge through cooperation was most manifest in joint astronomical projects, the idea of gathering and comparing data from differing places of observation appears also in other fields, from experimental philosophy to natural studies or medicine. The effects of these developments are studied and explained in connection to the Montesquieuan climate theories and the emerging pre-romantic ideas of man and society.