The adoption of Web 2.0 within enterprises : employees' perspectives

This project explores employees’ adoption of Web 2.0 within organisations. It shows that the adoption of Web 2.0 is a challenging and dynamic process that changes over time. The adoption is, also, influenced by a number of interrelated issues including: People Traits, Social Influence, Trust, Technological Attributes, Relevance of Web 2.0, Web 2.0 Maturity, Organisational Support, and Organisational Practice.

More than merely wicked : regulating sewage discharges and other unspeakable problems in environmental policy-making and planning

While the communicative turn in policy-making has encouraged the public deliberation of policy decisions it has arguably had a more limited impact on the ability of public processes to deal with wicked problems. Wicked policy problems are characterised by high levels of complexity, uncertainty and divergence of values. However, some wicked problems present the additional challenge of high levels of psychosocial sensitivity and verbal proscription. Because these unspeakable policy problems frequently involve a significant moral dimension, the regulation of intimate processes or bodies, and strong elements of abjection and symbolic pollution they are quite literally problems that we don’t like to think about or talk about. However, the potential environmental and social impacts of these problems require that they be addressed. In this paper I present the preliminary findings of a research project focussed on the idea of the unspeakable policy problem and how its unspeakable nature can impact upon public participation and policy and environmental outcomes.

Young women's recent experience of labour and birth care in Queensland

Background Young parenthood continues to be an issue of concern in terms of clinical and psychosocial outcomes for mothers and their babies, with higher rates of medical complications such as preterm labour and hypertensive disease and a higher risk of depression. The aim of this study was to investigate how young age impacts on women's experience of intrapartum care. Methods Secondary analysis of data collected in a population based survey of women who had recently given birth in Queensland, comparing clinical and interpersonal aspects of the intrapartum maternity care experience for 237 eligible women aged 15–20 years and 6534 aged more than 20 years. Descriptive and multivariate analyses were undertaken. Results In the univariate analysis a number of variables were significantly associated with clinical aspects of labour and birth and perceptions of care: young women were more likely to birth in a public facility, to travel for birth and to live in less economically advantaged areas, to have a normal vaginal birth and to have one carer through labour. They were also less likely to report being treated with respect and kindness and talked to in a way they could understand. In logistic regression models, after adjustment for parity, other socio-demographic factors and mode of birth, younger mothers were still more likely to birth in a public facility, to travel for birth, to be more critical about interpersonal and aspects of care and the hospital or birth centre environment. Conclusion This study shows how experience of care during labour and birth is different for young women. Young women reported poorer quality interpersonal care which may well reflect an inferior care experience and stereotyping by health professionals, indicating a need for more effective staff engagement with young women at this time.

Self management of haemodialysis for end stage renal disease : a systematic review

Background Exploring self management in End Stage Renal Disease is extremely important for patients as they encounter several challenges including ongoing symptoms, complex treatments and restrictions, uncertainty about life and a dependency on technology, all of which impact upon their autonomy particularly after commencement of haemodialysis. Objective To summarise the effects of nursing interventions which effect selfmanagement of haemodialysis for patients with End Stage Renal Disease. Search strategy Search terms were chosen after reviewing text words and MeSH terms in relevant articles and databases. An extensive search of the literature from 1966 to June 2009 was conducted across a range of health databases including Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science. Further studies were identified from reference lists of all retrieved studies. Selection criteria We considered randomised controlled trials that compared interventions to improve self management of haemodialysis in patients with ESRD. In the absence of RCTs, comparative studies without randomisation as well as before and after studies were considered for inclusion. Methodological quality Study reports selected for retrieval were assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information package (SUMARI). Data collection and analysis Data was extracted using the JBI data extraction tool for evidence of effectiveness independently by pairs of review authors. The evidence was reported in narrative summaries due to heterogeneity of the interventions of the studies. Results and conclusions Five randomised controlled trials were included in the review. Overall, the evidence found that psychosocial and educational interventions influenced self management of haemodialysis in this patient population.

Development and formative evaluation of a motorcycle rider training intervention to address risk taking

The need to address on-road motorcycle safety in Australia is important due to the disproportionately high percentage of riders and pillions killed and injured each year. One approach to preventing motorcycle-related injury is through training and education. However, motorcycle rider training lacks empirical support as an effective road safety countermeasure to reduce crash involvement. Previous reviews have highlighted that risk-taking is a contributing factor in many motorcycle crashes, rather than merely a lack of vehicle-control skills (Haworth & Mulvihill, 2005; Jonah, Dawson & Bragg, 1982; Watson et al, 1996). Hence, though the basic vehicle-handling skills and knowledge of road rules that are taught in most traditional motorcycle licence training programs may be seen as an essential condition of safe riding, they do not appear to be sufficient in terms of crash reduction. With this in mind there is considerable scope for the improvement of program focus and content for rider training and education. This program of research examined an existing traditional pre-licence motorcycle rider training program and formatively evaluated the addition of a new classroom-based module to address risky riding; the Three Steps to Safer Riding program. The pilot program was delivered in the real world context of the Q-Ride motorcycle licensing system in the state of Queensland, Australia. Three studies were conducted as part of the program of research: Study 1, a qualitative investigation of delivery practices and student learning needs in an existing rider training course; Study 2, an investigation of the extent to which an existing motorcycle rider training course addressed risky riding attitudes and motives; and Study 3, a formative evaluation of the new program. A literature review as well as the investigation of learning needs for motorcyclists in Study 1 aimed to inform the initial planning and development of the Three Steps to Safer Riding program. Findings from Study 1 suggested that the training delivery protocols used by the industry partner training organisation were consistent with a learner-centred approach and largely met the learning needs of trainee riders. However, it also found that information from the course needs to be reinforced by on-road experiences for some riders once licensed and that personal meaning for training information was not fully gained until some riding experience had been obtained. While this research informed the planning and development of the new program, a project team of academics and industry experts were responsible for the formulation of the final program. Study 2 and Study 3 were conducted for the purpose of formative evaluation and program refinement. Study 2 served primarily as a trial to test research protocols and data collection methods with the industry partner organisation and, importantly, also served to gather comparison data for the pilot program which was implemented with the same rider training organisation. Findings from Study 2 suggested that the existing training program of the partner organisation generally had a positive (albeit small) effect on safety in terms of influencing attitudes to risk taking, the propensity for thrill seeking, and intentions to engage in future risky riding. However, maintenance of these effects over time and the effects on riding behaviour remain unclear due to a low response rate upon follow-up 24 months after licensing. Study 3 was a formative evaluation of the new pilot program to establish program effects and possible areas for improvement. Study 3a examined the short term effects of the intervention pilot on psychosocial factors underpinning risky riding compared to the effects of the standard traditional training program (examined in Study 2). It showed that the course which included the Three Steps to Safer Riding program elicited significantly greater positive attitude change towards road safety than the existing standard licensing course. This effect was found immediately following training, and mean scores for attitudes towards safety were also maintained at the 12 month follow-up. The pilot program also had an immediate effect on other key variables such as risky riding intentions and the propensity for thrill seeking, although not significantly greater than the traditional standard training. A low response rate at the 12 month follow-up unfortunately prevented any firm conclusions being drawn regarding the impact of the pilot program on self-reported risky riding once licensed. Study 3a further showed that the use of intermediate outcomes such as self-reported attitudes and intentions for evaluation purposes provides insights into the mechanisms underpinning risky riding that can be changed by education and training. A multifaceted process evaluation conducted in Study 3b confirmed that the intervention pilot was largely delivered as designed, with course participants also rating most aspects of training delivery highly. The complete program of research contributed to the overall body of knowledge relating to motorcycle rider training, with some potential implications for policy in the area of motorcycle rider licensing. A key finding of the research was that psychosocial influences on risky riding can be shaped by structured education that focuses on awareness raising at a personal level and provides strategies to manage future riding situations. However, the formative evaluation was mainly designed to identify areas of improvement for the Three Steps to Safer Riding program and found several areas of potential refinement to improve future efficacy of the program. This included aspects of program content, program delivery, resource development, and measurement tools. The planned future follow-up of program participants' official crash and traffic offence records over time may lend further support for the application of the program within licensing systems. The findings reported in this thesis offer an initial indication that the Three Steps to Safer Riding is a useful resource to accompany skills-based training programs.

The effect of varied test instructions on neuropsychological performance following mild traumatic brain injury : an investigation of ‘diagnosis threat’

Diagnosis threat is a psychosocial factor that has been proposed to contribute to poor outcomes following mild traumatic brain injury (mTBI). This threat is thought to impair the cognitive test performance of individuals with mTBI because of negative injury stereotypes. University students (N= 45, 62.2% female) with a history of mTBI were randomly allocated to a diagnosis threat (DT, n=15), reduced threat (DT-reduced, n=15) or neutral (n=15) group. The reduced threat condition invoked a positive stereotype (i.e., that people with mTBI can perform well on cognitive tests). All participants were given neutral instructions before they completed baseline tests of: a) objective cognitive function across a number of domains; b) psychological symptoms; and, c) PCS symptoms, including self-reported cognitive and emotional difficulties. Participants then received either neutral, DT or DT-reduced instructions, before repeating the tests. Results were analyzed using separate mixed model ANOVAs; one for each dependent measure. The only significant result was for the 2 X 3 ANOVA on an objective test of attention/working memory, Digit Span, p<.05, such that the DT-reduced group performed better than the other groups, which were not different from each other. Although not consistent with predictions or earlier DT studies, the absence of group differences on most tests fits with several recent DT findings. The results of this study suggest that it is timely to reconsider the role of DT as a unique contributor to poor mTBI outcome.

Hepatitis C, mental health and equity of access to antiviral therapy : a systematic narrative review

Introduction Access to hepatitis C (hereafter HCV) antiviral therapy has commonly excluded populations with mental health and substance use disorders because they were considered as having contraindications to treatment, particularly due to the neuropsychiatric effects of interferon that can occur in some patients. In this review we examined access to HCV interferon antiviral therapy by populations with mental health and substance use problems to identify the evidence and reasons for exclusion. Methods We searched the following major electronic databases for relevant articles: PsycINFO, Medline, CINAHL, Scopus, Google Scholar. The inclusion criteria comprised studies of adults aged 18 years and older, peer-reviewed articles, date range of (2002--2012) to include articles since the introduction of pegylated interferon with ribarvirin, and English language. The exclusion criteria included articles about HCV populations with medical co-morbidities, such as hepatitis B (hereafter HBV) and human immunodeficiency virus (hereafter HIV), because the clinical treatment, pathways and psychosocial morbidity differ from populations with only HCV. We identified 182 articles, and of these 13 met the eligibility criteria. Using an approach of systematic narrative review we identified major themes in the literature. Results Three main themes were identified including: (1) pre-treatment and preparation for antiviral therapy, (2) adherence and treatment completion, and (3) clinical outcomes. Each of these themes was critically discussed in terms of access by patients with mental health and substance use co-morbidities demonstrating that current research evidence clearly demonstrates that people with HCV, mental health and substance use co-morbidities have similar clinical outcomes to those without these co-morbidities. Conclusions While research evidence is largely supportive of increased access to interferon by people with HCV, mental health and substance use co-morbidities, there is substantial further work required to translate evidence into clinical practice. Further to this, we conclude that a reconsideration of the appropriateness of the tertiary health service model of care for interferon management is required and exploration of the potential for increased HCV care in primary health care settings.

Bioecological factors influencing women's alcohol consumption across the life span

Background Substantial changing trends in women’s alcohol consumption show increased proportions women drinking at risky/ high risk levels. Not confined to the younger female population, these increases are also occurring in older female age groups (aged 35 and over), posing a set of risks differing to those of their male counterparts. However, little research investigates the influences behind these changing trends. The current research examined multiple level influences (i.e. cultural, social and psychosocial on women’s drinking across a range of age groups. Methods Semi-structured telephone interviews were conducted with thirty-five women (aged 18-55) residing in Australia. Interview development was guided by an adaptation of Bronfenbrenner’s Bioecological Model of Development to assess multiple areas of influences from cultural through to psychosocial (i.e. intra-individual). Each interview took approximately 1 hour to complete. Findings Bronfenbrenner’s Bioecological Model could account for multiple-level factors impacting women’s drinking with multidirectional influences interacting across each level. Cultural influences included gender roles and national identity. Exosystem influences (e.g. infrastructure, legislation, and media) and microsystem influences (e.g. drinking context, family, partner and peer influence) were clearly identified as impacting drinking behaviours. Finally, at the psychosocial level, attitudes and expectations around the disinhibiting effects of alcohol and social facilitation emerged as key influences. Discussion The outcomes indicated the importance of these influences as women’s alcohol-related attitudes and behaviours changed across a woman’s life span and across age cohorts. Future research will build on these initial findings in order to underpin targeted interventions of the key factors influencing women’s drinking.

Prospective observational study of dementia and delirium in the acute hospital setting

Background: Dementia and delirium appear to be common among older patients admitted to acute hospitals, although there are few Australian data regarding these important conditions. Aim: The aim of this study was to determine the prevalence and incidence of dementia and delirium among older patients admitted to acute hospitals in Queensland and to profile these patients. Method: Prospective observational cohort study (n = 493) of patients aged 70 years and older admitted to general medical, general surgical and orthopaedic wards of four acute hospitals in Queensland between 2008 and 2010. Trained research nurses completed comprehensive geriatric assessments and obtained detailed information about each patient’s physical, cognitive and psychosocial functioning using the interRAI Acute Care and other standardised instruments. Nurses also visited patients daily to identify incident delirium. Two physicians independently reviewed patients’ medical records and assessments to establish the diagnosis of dementia and/or delirium. Results: Overall, 29.4% of patients (n = 145) were considered to have cognitive impairment, including 102 (20.7% of the total) who were considered to have dementia. This rate increased to 47.4% in the oldest patients (aged 90 years). The overall prevalence of delirium at admission was 9.7% (23.5% in patients with dementia), and the rate of incident delirium was 7.6% (14.7% in patients with dementia). Conclusion: The prevalence of dementia and delirium among older patients admitted to acute hospitals is high and is likely to increase with population aging. It is suggested that hospital design, staffing and processes should be attuned better to meet these patients’ needs.

An evaluation of dog-assisted therapy for residents of aged care facilities with dementia.

Although some research suggests that dog-assisted therapy may be beneficial for people with dementia living in residential aged care facilities, the intervention has not been adequately investigated. To address this shortcoming, we conducted a randomized controlled trial of dog-assisted therapy versus a human-therapist-only intervention for this population. Fifty-five residents with mild to moderate dementia living in three Australian residential aged care facilities completed an 11-week trial of the interventions. Allocation to the intervention was random and participants completed validated measures of mood, psychosocial functioning, and quality of life (QOL), both prior to and following the intervention. No adverse events were associated with the dog-assisted intervention, and following it participants who had worse baseline depression scores demonstrated significantly improved depression scores relative to participants in the human-therapist-only intervention. Participants in the dogassisted intervention also showed significant improvements on a measure of QOL in one facility compared with those in the human-therapist-only group (although worse in another facility that had been affected by an outbreak of gastroenteritis). This study provides some evidence that dog-assisted therapy may be beneficial for some residents of aged care facilities with dementia.

Adding SUGAR : service user and carer collaboration in mental health nursing research

‘SUGAR: Service users and carers group advising on research’ is an exciting initiative established to develop collaborative working in mental health nursing research between mental health service users, carers, researchers and practitioners at City University London, UK. This paper will describe the background to SUGAR and how and why it was established; how the group operates; some of the achievements to date including researcher reflections; and case studies of how this collaboration influences our research. Written reflective narratives of service user and carer experiences of SUGAR were analysed using constant comparative methods by the members. Common themes are presented with illustrative quotes. The article highlights the benefits and possible limitations identified so far by members of SUGAR; outlines future plans and considers the findings in relation to literature on involvement and empowerment. This paper has been written by staff and members of SUGAR and is the first venture into collaborative writing of the group and reflects the shared ethos of collaborative working.

The effectiveness of non-pharmacological interventions in improving psychological outcomes for heart transplant recipients : a systematic review

Background Post-heart transplant psychological distress may both directly hinder physiological health as well as indirectly impact on clinical outcomes by increasing unhealthy behaviours, such as immunosuppression non-adherence. Reducing psychological distress for heart transplant recipients is therefore vitally important, in order to improve patients’ overall health and well-being but also clinical outcomes, such as morbidity and mortality. Evidence from other populations suggests that non-pharmacological interventions may be an effective strategy. Aim To appraise the efficacy of non-pharmacological interventions on psychological outcomes after heart transplant. Method A systematic review was conducted using the Joanna Briggs Institute methodology. Experimental and quasi-experimental studies that involved any non-pharmacological intervention for heart transplant recipients were included, provided that data on psychological outcomes were reported. Multiple electronic databases were searched for published and unpublished studies and reference lists of retrieved studies were scrutinized for further primary research. Data were extracted using a standardised data extraction tool. Included studies were assessed by two independent reviewers using standardised critical appraisal instruments. Results Three studies fulfilled the inclusion and exclusion criteria, which involved only 125 heart transplant recipients. Two studies reported on exercise programs. One study reported a web-based psychosocial intervention. While psychological outcomes significantly improved from baseline to follow-up for the recipients who received the interventions, between-group comparisons were not reported. The methodological quality of the studies was judged to be poor. Conclusions Further research is required, as we found there is insufficient evidence available to draw conclusions for or against the use of non-pharmacological interventions after heart transplant.

Supportive and palliative care for lung cancer patients

Lung cancer patients face poor survival and experience co-occurring chronic physical and psychological symptoms. These symptoms can result in significant burden, impaired physical and social function and poor quality of life. This paper provides a review of evidence based interventions that support best practice supportive and palliative care for patients with lung cancer. Specifically, interventions to manage dyspnoea, one of the most common symptoms experienced by this group, are discussed to illustrate the emerging evidence base in the field. The evidence base for the pharmacological management of dyspnoea report systemic opioids have the best available evidence to support their use. In particular, the evidence strongly supports systemic morphine preferably initiated and continued as a once daily sustained release preparation. Evidence supporting the use of a range of other adjunctive non-pharmacological interventions in managing the symptom is also emerging. Interventions to improve breathing efficiency that have been reported to be effective include pursed lip breathing, diaphragmatic breathing, positioning and pacing techniques. Psychosocial interventions seeking to reduce anxiety and distress can also improve the management of breathlessness although further studies are needed. In addition, evidence reviews have concluded that case management approaches and nurse led follow-up programs are effective in reducing breathlessness and psychological distress, providing a useful model for supporting implementation of evidence based symptom management strategies. Optimal outcomes from supportive and palliative care interventions thus require a multilevel approach, involving interventions at the patient, health professional and health service level.

The affordances of social technology : a BPM perspective

Increasingly, organizations are looking to employ Social Technology (ST) to enhance their capability with Business Process Improvement (BPI). However, little is known about how the characteristics or qualities of ST actually influence an organizations' capability at Business Process Improvement (BPI). This paper discusses the potential role of ST in process improvement by presenting an a-priory model derived by an investigation of extant research. First, the qualities of social technology that potentially support high level action possibilities related to BPI are presented (we refer to these as affordances), next these affordances are mapped to the De Bruin (2009) BPM Maturity model as a first step to understanding how ST influences BPI. This work is expected to contribute to our knowledge and understanding of the relationship between ST and BPI, and will extend existing theory on Business Process Management capability and maturity.