The experiences and adjustments of women following their first acute myocardial infarction

Very little is known about cardiovascular disease (CVD) in women and their specific needs throughout their recovery process. This study aimed to explore the experiences and adjustments of women following their first AMI. Naturalistic inquiry was used and six women were interviewed post their first AMI. Two major themes were identified: (1) 'the initial experience/event' which identifies events and emotions leading up to, and during, the hospital admission; and (2) 'support: for who and how' exploring the importance of support throughout the recovery process.

The women in this study did not see themselves at risk of an AMI regardless of their lifestyles and when it did occur they adopted a variety of coping mechanisms in order to adjust to their trauma. The findings highlight the need for an increase in community awareness and education surrounding the risk factors of heart disease and its signs and symptoms, to minimize delayed hospital presentations.

Haemodynamic instability after cardiac surgery: nurses` perceptions of clinical decision-making

Background. Cardiac surgical patients are distinguished by their potential for instability in the early postoperative period, highly invasive haemodynamic monitoring technologies and unique clinical presentations as a result of undergoing cardiopulmonary bypass. Little is known about nurses’ perceptions of assuming responsibility for such patients. An nderstanding of nurses’ perceptions may identify areas of practice that can be improved and assist in determining the adequacy of current decision supports.

Aim. The aim of this study was to describe critical care nurses’ perceptions of assuming responsibility for the nursing management of cardiac patients in the initial two-hour postoperative period. Design. An exploratory descriptive study based on naturalistic decision-making.

Methods. Thirty-eight nurses were interviewed immediately following a two-hour observation of their clinical practice. Content analysis and a systematic thematic analysis process called ‘Framework’ were used to analyse the interview transcripts.

Results. Nurses described their perceptions of managing patients in terms of how they felt about making decisions for complex cardiac surgical patients and in terms of how clinical processes unique to the admission phase impacted their decision-making. Nurses felt either daunted or stimulated and challenged when making decisions. Nurses identified handover from anaesthetists, settling in procedures and forms of
collegial assistance as important processes that impacted their decision-making.

Conclusion. Nurses’ previous experiences with similar patients influenced how they felt about making decisions during the initial two-hour postoperative period, but did not alter their views about processes important for patient safety during this time. Relevance to clinical practice. Feelings expressed by nurses in this study highlight the need for clinical supervision and appropriate allocation of resources during the immediate recovery period after cardiac surgery. Nurses identified ways to improve clinical processes that impacted their decision-making during the immediate recovery of cardiac surgical patients.

The influence of patient complexity and nurses` experience on haemodynamic decision-making following cardiac surgery

Critical care nurses’ haemodynamic decision-making in the immediate postoperative cardiac surgical context is complex. To optimise patient outcomes, nurses of varying levels of experience are required to make complex decisions rapidly and accurately. In a dynamic clinical context such as critical care, the quality of such decision-making is likely to vary considerably. The aim of this study was to describe variability of nurses’ haemodynamic decision-making in the 2-hour period after cardiac surgery as a function of interplay between decision complexity, nurses’ levels of experience, and the support provided. A descriptive study based on naturalistic decision-making was used. Data were collected using continuous non-participant observation of clinical practice for a 2-hour period and follow-up interview. Purposive sampling was used to recruit 38 nurses for inclusion in the study. The quality of nurses’ decision-making was influenced by interplay between the complexity of patients’ haemodynamic presentations, nurses’ levels of cardiac surgical intensive care experience, and the form of decision support provided by nursing colleagues. Two factors specifically influenced decision-making quality: nurses’ utilisation of evidence for practice and the experience levels of both nurses and their colleagues. The findings have implications for staff resourcing decisions and postoperative patient management, and may be used to inform nurses’ professional development and education.

Flexible learning for quality in higher education

This keynote presentation is in two related parts. The first deals deal with the issue of the background, context and issues concerned with the emergence of flexible learning and flexible delivery in education, especially in higher education and its interrelationships with the background, context and issues concerned with the emergence of' quality' in higher education. The second explores the issues concerned with the use of online media to facilitate quality flexible learning in higher education.

These presentations draw on authors teaching and research in these fields. In particular they draw on their work on the interrelationships between educational technology, interaction and dialogue in the development of 'quality' education. It is shown that, at institutional and individual levels, decisions are made to implement flexible and online forms of education that have significant curricula and pedagogical implications, not only for those institutions and individuals (teachers), but most importantly for the learners and their contexts. The rhetoric that advocates the implementation of flexible learning and online education may well be grounded in positive ideas for change, but the institutional and individual consequences the costs and benefits- are not always clearly understood from the outset.

The recent developments in information and communication technologies have enabled many institutions to provide courses flexibly using online learning. Maintaining quality in course provision, online teaching and support infrastructure has proved an important issue in higher education, as provision of technology alone is only a small part of ensuring quality in flexible learning. The possibilities of higher education without borders means that such issues of online quality be addressed and these presentations wiII draw on experiences from both international and Deakin University perspective.

A model of online teaching and learning

Deakin University has a long history of supporting distance education with technology. Such presentations have matured from a mix of remote-login/FTP/email in the 1980s through web mediated access in the 1990s to institution-wide learning management systems which are emerging currently. By the commencement of semester I, 2003, online teaching at the University will be supported by a single, institution-wide, learning management system, which is expected to support approximately 28,000 students, who will each be accessing up to 4 of some 1500 undergraduate and 700 postgraduate courses. In this paper we describe a model for online teaching of both on-campus and off-campus students in the Bachelor of Computing, using various technologies to support different aspects of online teaching and learning. This programme has been running in a web-mediated environment for over six years. Each year the administration of the programme has been modified in a reactive manner, based on student feedback and the identification of failure points during the previous semester, resulting in the model maturing over that time. We discuss how the changes have impacted the model, the academics involved in the teaching of the unit and the students' experience of learning in the online environment. We also discuss the advantages and disadvantages of online teaching and learning, as well as some potential pitfalls and how to avoid them, or, at least, minimise their impact.

The first 50 years of the annual endowed accounting research lecture series at the University of Melbourne

Carnegie and Edwards (2001) suggest that the formation of an organisational body is just one of the 'signals of movement' within the dynamic process of professionalisation of an occupation and they list the sponsoring of professorial posts and research activities at universities as further examples. While the literature on this process in Australia does refer to the sponsorship of chairs of accounting (Carnegie & Williams, 2001), little has been written identifying the range of other areas of sponsorship by the organised accounting bodies. This paper presents details of the first fifty years presentations of the Annual Accounting Research Lectures held at The University of Melbourne, Australia. They have been presented continuously since 1940, when they were inaugurated with sponsorship from the Commonwealth Institute of Accountants. The paper presents the first complete listing of details relating to the presenter (including name, gender, residency and occupational area), title of the paper, date of presentation (where known) and details of publication (where appropriate). The initial and subsequent motivation for the presentation of the series and the influence of the lectures in promoting research and fostering relations between the professional bodies and the university, during a period of great significance in the development of accounting education and the professionalisation of accounting in Australia, is also discussed.

Touch it, feel it and experience it: developing professional IS skills using interview-style experiential simulations

The IS education field has made increasing use of computerised experiential simulations, but few attempts have been made to create an authentic learning environment that combines and balances elements of video-based computer simulation with real-life learning activities. This paper explores the design principles used to develop a CD-ROM simulation where learners use interviewing skills to elicit system requirements from simulated employees in an authentic context. The employees are videoed actors who converse with each other and with learners within a dynamic interaction model. The paper also describes how we combined this simulation with other teaching approaches such as in-class discussions, student team work, formal presentations, etc.

Digitisation and copyright compliance for course materials and library reserve materials at Deakin University

A digitisation effort employed by Deakin University Library has proven to be of great benefit to its distance and lifelong learners. This paper discusses issues involved with digitisation and copyright compliance issues associated with producing electronic information resources made available to distance and lifelong learners at Deakin University. The authors discus the balance between print and e-reserves, the differences in course-pack content and electronic reserves and the copyright compliance issues that regulate fair access. Budgetary concerns, in terms of staff time, computer equipment were weighed to determine efficiency. The project was carried out in several phases, beginning with the digitisation of class notes, exams, class presentations, and finally with the materials covered within copyright regulations. A respective project would complete the project. It was found that there was a significant financial savings in the digitisation of electronic reserves, yet the main goal was to better serve the remote user with enhanced access. Relevant screenshots and bibliography are included. M. Thomas.

Issues arising from the implementation of a comprehensive assessment approach in a large, multi-modal Bachelor of Commerce Unit

Recent literature in higher education argues university assessment has been too narrow and hasn’t adequately reflected the quality, breadth and depth of students’ learning. Research shows students often prioritise and learn what they need to know for formal, graded assessment and disregard other academic content seen as less relevant to those requirements. The predominance of essays and examinations has therefore tended to constrain learning. The case for a more comprehensive approach has been clearly articulated. So what happens when staff take up the unique challenge of designing fair and uniform assessment for a large, core, multi-modal, multi-campus unit offered nationally and internationally?
When developing an undergraduate Bachelor of Commerce unit at Deakin University, staff considered the most appropriate ways to assess a range of conceptual understandings and communication skills. This resulted in the mapping and adoption of a comprehensive approach incorporating teacher, peer, and self-assessment aspects, individual and group work, oral and written presentations, and the use of portfolios and journals. Particular practices were adopted to control workloads, ensure fairness in marking, and overcome some problems generally associated with group work. When implementing the approach, practical issues arose that demanded adjustments. This paper details the approach taken, outlines research activities, and discusses the practical implications of issues that arose.

Implementing an online audio lecture streaming facility

This paper describes our experiences in implementing an audio lecture streaming facility for Deakin University. For many years Deakin students have benefited from some of the most comprehensive printed study notes of any university in Australia. In 2002, portable digital audio recorders were utilised by academic staff to capture lecture presentations in order to supplement existing unit learning materials and teaching delivery methods. Audio recordings were processed to enable streamed access via the web browser interface using QuickTime. A trial of incorporating PowerPoint presentations was conducted on a limited basis. 68 undergraduate and postgraduate units implemented lecture streaming. This represented over1700 lecture recordings and 20000 audio streams. Evaluation findings indicate that students find this facility highly valuable to their studies and regularly access the audio recordings throughout semester. Benefits include; access to lecture presentations for off-campus enrolled students, the ability to revisit lecture presentations, and the ability to study at a place and time of convenience. Future enhancement to the audio lecture streaming may include implementing a hard-wired audio capture system into lecture theatres and providing for a more rapid turn around of audio processing.

A systematic approach to learning aimed at graduate physiotherapists practicing in South West Victoria

Mandatory standards developed by allied health professions for registration and accreditation purposes require continuing professional development (CPD) that can be accessed by all professionals, particularly those practicing in regions removed from the bigger cities. To improve and maintain competencies and standards of care CPD programs need to be accessible and provide opportunities for lifelong learning of efficacious evidence-based intervention. Despite the benefits of CPD, problems reported include access and lack of clarity on the usefulness of CPD in relation to clinical practice. The aim of this study was to develop a CPD program for physiotherapists in the south west of Victoria by employing a systematic approach that included a needs assessment as a vehicle to compose the 2004/2005 program and to optimise ease of attendance, relevance and perceived applicability to clinical practice. The education delivered was purposely in line with the principles of adult learning and presenters were instructed to focus for at least one-third of the workshop time on praxis. This study measured attendance levels throughout the program and satisfaction with the education received in terms of perceived clinical benefits in order to understand the benefits of employing detailed local needs assessments for rural professionals. All workshops and presentations were evaluated with regard to suitability of the venue, presenter style, content, applicability to clinical practice and overall impression by using 7-point Likert scales. Modes and medians both were 7, with seven being rated as highly successful. Attendance was high, 57.2% attended four or more sessions and 68.6% attended at least one workshop in the clinic over the period. In addition, 22.9% attended at least one of the two conducted courses that were held in that period. Although most physiotherapists (68.6%) reported some effect, 20% of the physiotherapists perceived that the CPD program had a large effect on their clinical skills and 29.4% found that patient demand had increased. This paper will discuss the results in light of approaches for allied health workplace learning.

Review of the role of emergency nurses in management of chemotherapy-related complications

Aims and objectives : To examine the role of emergency nurses in caring for patients who receive chemotherapy in ambulatory oncology settings. Reasons for emergency department presentations are examined, specific sources of clinical risk for patients receiving chemotherapy who require emergency care are discussed and cost implications of emergency department presentations related to chemotherapy are analysed.

Background : Given the increased administration of chemotherapy in ambulatory settings, emergency nurses play an important role in the management of patients undergoing adjuvant chemotherapy. Emergency departments are the major entry point for acute inpatient hospital care of complications arising from chemotherapy.

Design : Systematic review.

Results : Chemotherapy-related emergency department presentations have considerable clinical and cost implications for patients and the healthcare system. Strategies to improve emergency department management of chemotherapy complications and reduction in preventable emergency department presentations has significant implications for improving cancer patients' quality of life and reducing the cost of cancer care.

Conclusions : Nurses are well placed to play a pivotal role in chemotherapy management and lead interventions such as a specialist oncology nursing roles that provide information and support to guide patients through their chemotherapy cycles. These interventions may prevent emergency department presentations for patients receiving chemotherapy in ambulatory settings.

Relevance to clinical practice : Patients receiving chemotherapy require access to specialised care to manage distressing symptoms, as they are at significant clinical risk because of immunosuppression and may not exhibit the usual signs of critical illness. A team approach both within and across nursing specialities may improve care for patients receiving chemotherapy and increase effective use of healthcare resources.