Creating a therapeutic environment : a non-randomised controlled trial of a quiet time intervention for patients in acute care

Background: Noise is a significant barrier to sleep for acute care hospital patients, and sleep has been shown to be therapeutic for health, healing and recovery. Scheduled quiet time interventions to promote inpatient rest and sleep have been successfully trialled in critical care but not in acute care settings. Objectives: The study aim was to evaluate as cheduled quiet time intervention in an acute care setting. The study measured the effect of a scheduled quiet time on noise levels, inpatients’ rest and sleep behaviour, and wellbeing. The study also examined the impact of the intervention on patients’, visitors’ and health professionals’ satisfaction, and organisational functioning. Design: The study was a multi-centred non-randomised parallel group trial. Settings: The research was conducted in the acute orthopaedic wards of two major urban public hospitals in Brisbane, Australia. Participants: All patientsadmitted to the two wards in the5-month period of the study were invited to participate, withafinalsample of 299 participants recruited. This sample produced an effect size of 0.89 for an increase in the number of patients asleep during the quiet time. Methods: Demographic data were collected to enable comparison between groups. Data for noise level, sleep status, sleepiness and well being were collected using previously validated instruments: a Castle Model 824 digital sound level indicator; a three point sleep status scale; the Epworth Sleepiness Scale; and the SF12 V2 questionnaire. The staff, patient and visitor surveys on the experimental ward were adapted from published instruments. Results: Significant differences were found between the two groups in mean decibel level and numbers of patients awake and asleep. The difference in mean measured noise levels between the two environments corresponded to a ‘perceived’ difference of 2 to 1. There were significant correlations between average decibel level and number of patients awake and asleep in the experimental group, and between average decibel level and number of patients awake in the control group. Overall, patients, visitors and health professionals were satisfied with the quiet time intervention. Conclusions: The findings show that a quiet time intervention on an acute care hospital ward can affect noise level and patient sleep/wake patterns during the intervention period. The overall strongly positive response from surveys suggests that scheduled quiet time would be a positively perceived intervention with therapeutic benefit.

The relationship between Internet use and perceived performance in retail and professional service firms

lnformation technology (IT) and, in particular, the Internet is dramatically impacting on the services sector. This paper specifically investigates the relative impact of several forms of internet use on perceived performance for two groups of service organisations - retail service firms and professlonal health service firms. Using a mailed out self-administered questionnaire, 625 completed questionnaires were obtained and 43 per cent of respondents reported that they used the lternet. Thus the final usable sample in the study comprised 262 respondents. Results showed that the Internet does significantly influence perceived performance in both types of service firms. However,there are differences in the forms of lntemet use between the two service groups and their relative effect on performance. For retail firms, use of transactional function, such as ordering, selling and payment was found to be positively related to increases in perceived performance. In contrast, for professional health service firms, the ability to search for information on products and/or services was found to be positively associated with perceived performance. Finally, theoretical and managerial implications of the findings of this study are discussed.

Mobile communications : a study of factors influencing consumer use of m-services

New mobile digital communication technologies present opportunities for advertisers to capitalize on the evolving relationships of consumers with their mobile devices and their desire to access enhanced information services while mobile (m-services). Consumers already use mobile devices (cell phones, personal mobile digital assistants) for traditional phone calls and message handling (e.g., Kalakota and Robinson, 2002; Sullivan Mort and Drennan, 2002). The combination of rapidly developing mobile digital technology and high uptake rates of mobile devices presents enormous potential for delivery of m-services through these devices (Bitner, Brown, and Meuter, 2000). M-services encompass a wide variety of types including the ability to trade stock, to book theater and movie tickets while accessing seating plans online, to send and receive text and pictures, and receive personalized direct advertising such as alerts for shopping bargains. Marketing communications, and specifically advertising, may be delivered as an m-service and termed m-services advertising, forming part of the broader category of m-services. However, advertising research has not yet addressed the area of m-services and needs to do so to be able to take advantage of the advanced interactivity (Yadav and Varadarajan, 2005) of mobile communication devices. Such advertising research is likely to help develop open attitudes and responses to new business models as has been advocated for other new technology such as advanced television (Tauder, 2005). In this article, we model the factors influencing the use of m-services, in the context of consumers' existing relationships with mobile devices. First, we address the value propositions underpinning consumer involvement with mobile devices. Next, we canvass the types of involvement relevant to this consumption domain and argue that involvement, together with personal attributes innovativeness and self-efficacy, will influence use of m-services. Finally, implications for advertising delivered as an m-service are discussed, the potential for m-services advertising as part of m-commerce are canvassed, and directions for future research identified.

Screening for drugs in oral fluid : illicit drug use and drug driving in a sample of urban and regional Queensland motorists

Police services in a number of Australian states and overseas jurisdictions have begun to implement or consider random road-side drug testing of drivers. This paper outlines research conducted to provide an estimate of the extent of drug driving in a sample of Queensland drivers in regional, rural and metropolitan areas. Oral fluid samples were collected from 2657 Queensland motorists and screened for illicit substances including cannabis (delta 9 tetrahydrocannibinol [THC]), amphetamines, ecstasy, and cocaine. Overall, 3.8% of the sample (n = 101) screened positive for at least one illicit substance, although multiple drugs were identified in a sample of 23 respondents. The most common drugs detected in oral fluid were ecstasy (n = 53), and cannabis (n = 46) followed by amphetamines (n = 23). A key finding was that cannabis was confirmed as the most common self-reported drug combined with driving and that individuals who tested positive to any drug through oral fluid analysis were also more likely to report the highest frequency of drug driving. Furthermore, a comparison between drug vs. drink driving detection rates for one region of the study, revealed a higher detection rate for drug driving (3.8%) vs. drink driving (0.8%). This research provides evidence that drug driving is relatively prevalent on Queensland roads, and may in fact be more common than drink driving. This paper will further outline the study findings’ and present possible directions for future drug driving research.

The use of online counselling within an Australian secondary school setting: a practitioner’s viewpoint

This paper proposes that the provision of online counselling services for young people accessed through their local school website has the potential to assist students with mental health issues as well as increasing their help seeking behaviours. It stems from the work of the authors who trialled an online counselling service within one Australian secondary school. In Australia, online counselling with the adult population is now an accepted part of the provision of mental health services. Online provision of mental health information for young people is also well accepted. However, online counselling for young people is provided by only a few community organisations such as Kids Help Line within Australia. School based counselling services which are integral to most secondary schools in Australia, seem slow to provide this service in spite of initial interest and enthusiasm by individual school counsellors. This discussion is the product of reflection on the potential benefits of this trial with a consideration of relevant research of the issues raised. It highlights the need for further research into the use of computer mediated communication in the provision of counselling within a school setting.

Measuring the use of information and communication technologies (ICTs) in the classroom

In 2003, the “ICT Curriculum Integration Performance Measurement Instrument” was developed froman extensive review ofthe contemporary international and Australian research pertaining to the definition and measurement of ICT curriculum integration in classrooms (Proctor, Watson, & Finger, 2003). The 45-item instrument that resulted was based on theories and methodologies identified by the literature review. This paper describes psychometric results from a large-scale evaluation of the instrument subsequently conducted, as recommended by Proctor, Watson, and Finger (2003). The resultant 20-item, two-factor instrument, now called “Learning with ICTs: Measuring ICT Use in the Curriculum,” is both statistically and theoretically robust. This paper should be read in association with the original paper published in Computers in the Schools(Proctor, Watson, & Finger, 2003) that described in detail the theoretical framework underpinning the development of the instrument.

Regulating roles of the use of the balanced scorecard in shaping corporate identities

The literature on corporate identity management suggests that managing corporate identity is a strategically complex task embracing the shaping of a range of dimensions of organisational life. The performance measurement literature and its applications likewise now also emphasise organisational ability to incorporate various dimensions considering both financial and non-financial performance measures when assessing success. The inclusion of these soft non-financial measures challenges organisations to quantify intangible aspects of performance such as corporate identity, transforming unmeasurables into measurables. This paper explores the regulatory roles of the use of the balanced scorecard in shaping key dimensions of corporate identities in a public sector shared service provider in Australia. This case study employs qualitative interviews of senior managers and employees, secondary data and participant observation. The findings suggest that the use of the balanced scorecard has potential to support identity construction, as an organisational symbol, a communication tool of vision, and as strategy, through creating conversations that self-regulate behaviour. The development of an integrated performance measurement system, the balanced scorecard, becomes an expression of a desired corporate identity, and the performance measures and continuous process provide the resource for interpreting actual corporate identities. Through this process of understanding and mobilising the interaction, it may be possible to create a less obtrusive and more subtle way to control “what an organisation is”. This case study also suggests that the theoretical and practical fusion of the disciplinary knowledge around corporate identities and performance measurement systems could make a contribution to understanding and shaping corporate identities.

How is a fruit tree like you? Using artistic metaphors to explore and develop emotional competence in children

Counselling children often requires the use of supplementary strategies in order to interest and engage the child in the therapeutic process. One such strategy is the Metaphorical Fruit Tree (MFT); an art metaphor suited to exploring and developing self-concept. Quantitative and qualitative data was used to explore the relationships between children’s ability to use metaphor, age, gender, and level of emotional competence (N = 58). Quantitative and qualitative analyses revealed a significant negative relationship between self-reported emotional competence and ability to use the MFT. It is proposed that children rely on different processes to understand self and as children’s ability to cognitively report on their emotional capabilities via the Emotional Competence Questionnaire (ECQ) increases, their ability to report creatively on those capabilities via the MFT is undermined. It is suggested that the MFT may be used, via creative processes and as an alternative to cognitive processes, to increase understanding and awareness of intrapersonal and interpersonal concepts of self in the child during counselling.

Examination of the influence of personal attributes on consumer use on m-services

The rapid uptake of mobile devices has created the capacity to provide services to consumers while they are on the move, and new mobile services (m-services) are constantly emerging. In past research, personal attributes have been found to be import ant in the adoption and use of information and communication technology. However, little research has been conducted in the area of m-services. To explore factors influencing the use of these services, this paper examines personal attributes in terms of motivational, attitudinal and demographic characteristics. Specifically, it investigates the influence of innovativeness, self- efficacy, involvement and impulsiveness, as well as age and gender on m-services use . Data were collected from a convenience sample of 250 respondents using an online survey and a modified snowball procedure. Age and gender were quite well balanced in the sample. The multiple regression model was significant and the hypotheses relating to the positive relationship between impulsiveness, involvement and gender and m-services were supported. Findings are discussed, further implications for managers are suggested and directions for future research are proposed.

Nurse-determined assessment of cardiac output. Comparing a non-invasive cardiac output device and pulmonary artery catheter: a prospective observational study.

Background The accurate measurement of Cardiac output (CO) is vital in guiding the treatment of critically ill patients. Invasive or minimally invasive measurement of CO is not without inherent risks to the patient. Skilled Intensive Care Unit (ICU) nursing staff are in an ideal position to assess changes in CO following therapeutic measures. The USCOM (Ultrasonic Cardiac Output Monitor) device is a non-invasive CO monitor whose clinical utility and ease of use requires testing. Objectives To compare cardiac output measurement using a non-invasive ultrasonic device (USCOM) operated by a non-echocardiograhically trained ICU Registered Nurse (RN), with the conventional pulmonary artery catheter (PAC) using both thermodilution and Fick methods. Design Prospective observational study. Setting and participants Between April 2006 and March 2007, we evaluated 30 spontaneously breathing patients requiring PAC for assessment of heart failure and/or pulmonary hypertension at a tertiary level cardiothoracic hospital. Methods SCOM CO was compared with thermodilution measurements via PAC and CO estimated using a modified Fick equation. This catheter was inserted by a medical officer, and all USCOM measurements by a senior ICU nurse. Mean values, bias and precision, and mean percentage difference between measures were determined to compare methods. The Intra-Class Correlation statistic was also used to assess agreement. The USCOM time to measure was recorded to assess the learning curve for USCOM use performed by an ICU RN and a line of best fit demonstrated to describe the operator learning curve. Results In 24 of 30 (80%) patients studied, CO measures were obtained. In 6 of 30 (20%) patients, an adequate USCOM signal was not achieved. The mean difference (±standard deviation) between USCOM and PAC, USCOM and Fick, and Fick and PAC CO were small, −0.34 ± 0.52 L/min, −0.33 ± 0.90 L/min and −0.25 ± 0.63 L/min respectively across a range of outputs from 2.6 L/min to 7.2 L/min. The percent limits of agreement (LOA) for all measures were −34.6% to 17.8% for USCOM and PAC, −49.8% to 34.1% for USCOM and Fick and −36.4% to 23.7% for PAC and Fick. Signal acquisition time reduced on average by 0.6 min per measure to less than 10 min at the end of the study. Conclusions In 80% of our cohort, USCOM, PAC and Fick measures of CO all showed clinically acceptable agreement and the learning curve for operation of the non-invasive USCOM device by an ICU RN was found to be satisfactorily short. Further work is required in patients receiving positive pressure ventilation.

An investigation into the use of a blended model of learning in a first year accounting subject

The weaknesses of ‗traditional‘ modes of instruction in accounting education have been widely discussed. Many contend that the traditional approach limits the ability to provide opportunities for students to raise their competency level and allow them to apply knowledge and skills in professional problem solving situations. However, the recent body of literature suggests that accounting educators are indeed actively experimenting with ‗non-traditional‘ and ‗innovative‘ instructional approaches, where some authors clearly favour one approach over another. But can one instructional approach alone meet the necessary conditions for different learning objectives? Taking into account the ever changing landscape of not only business environments, but also the higher education sector, the premise guiding the collaborators in this research is that it is perhaps counter productive to promote competing dichotomous views of ‗traditional‘ and ‗non-traditional‘ instructional approaches to accounting education, and that the notion of ‗blended learning‘ might provide a useful framework to enhance the learning and teaching of accounting. This paper reports on the first cycle of a longitudinal study, which explores the possibility of using blended learning in first year accounting at one campus of a large regional university. The critical elements of blended learning which emerged in the study are discussed and, consistent with the design-based research framework, the paper also identifies key design modifications for successive cycles of the research.

Older patients request more information : a survey of use of written patient education materials in general practice

Objectives: To determine GPs' reported use of written education materials with older patients and older patients' reported receipt of these materials. To determine GPs' and older patients' perceptions of written materials.---------- Method: Using self-report questionnaires, two populations were surveyed; a randomised sample of 50 GPs (29 males and 21 females) practising in Brisbane's southern suburbs and a convenience sample of 188 older community-dwelling people (aged over 64 years).----------- Results: All GPs reported using written materials with patients, although 28% had not given any to the Last 10 patients. This increased to 46% when patients were older. Twenty percent of patients wanted more written information from their GP, while some GPs believed that older patients preferred verbal information and gave out written information only when they perceived patient interest. All GPs reported giving written materials at the time of consultation and over two thirds discussed the content with patients. Just over 50% of patients reported receiving written information from GPs in the Last six months and only hall of these again discussed it directly with their GP. Overall, patients were more positive than GPs about the value of written education materials.---------- Conclusions: Older patients' desire for written information may be better met if they are more assertive in requesting this of GPs and GPs may better serve their patients' needs if they make written information more readily available to them. Better access to materials and more financial incentives to give them out might also increase GPs' use of written materials.

Stem cell technologies : regulation, patents and problems

Human embryonic stem cell research promises to deliver in the future a whole range of therapeutic treatments, but currently governments in different jurisdictions must try to regulate this burgeoning area. Part of the problem has been, and continues to be, polarised community opinion on the use of human embryonic stem cells for research. This article compares the approaches of the Australian, United Kingdom and United States governments in regulating human embryonic stem cell research. To date, these governments have approached the issue through implementing legislation or policy to control research. Similarly, the three jurisdictions have viewed the patentability of human embryonic stem cell technologies in their own ways with different policies being adopted by the three patent offices. This article examines these different approaches and discusses the inevitable concerns that have been raised due to the lack of a universal approach in relation to the regulation of research; the patenting of stem cell technologies; and the effects patents granted are having on further human embryonic stem cell research.