Barriers and enablers to learning during team-based clinical simulations: reflective interviews with final year undergraduate nursing students

Background: Contemporary approaches to clinical simulation can enhance educational outcomes. However, simulation approaches do have limitations with possible compromises for learning and teaching. This paper aims to identify barriers
and enablers to learning in simulated clinical settings.
Methods: A generic qualitative design was applied. Semi-structured group video debriefing interviews were held with Australian final-year nursing students who completed three patient deterioration scenarios with a standardized patient.
Audio-recorded interviews were transcribed and analysed to identify emergent themes.
Results: Interviews with 15 teams of three students (n = 45) from three universities were analysed. Learning enablers were ‘Realism of the simulated environment’; ‘Practicing: we should do this at uni’; ‘Learning from reflection and expert feedback’, and ‘How to become competent: know the gaps’. Barriers to learning included ‘Increased stress from inexperience; ‘Expectations when pretending’ and ‘Lack of assistance’. Skills practice in team-based settings with applicable reflection and debriefing was regarded as beneficial. Simulated patients enhanced fidelity but were unable to replicate actual clinical signs. High stress levels were perceived as a barrier to learning.
Conclusions: Applicably designed high fidelity simulations with video-based reflective review offer repeated rehearsal of clinical situations to enable learning. This educational strategy may reduce the time it takes undergraduate students to
reach competency.

First-time offender, productive offender, offender with dependents: why the profile of offenders (sometimes) matters in sentencing

Should a single mother of four young children who commits theft be sentenced to a lesser sanction than a woman who commits the same crime but has no dependents? Should a billionaire philanthropist be sentenced to a lesser penalty than the average citizen for assaulting a random bystander? Should a first-time thief receive a lighter sanction than a career thief for the same theft? The relevance of an offender’s profile to sentencing is unclear and is one of the most under-researched and least coherent areas of sentencing law. Intuitively, there is some appeal in treating offenders without a criminal record, those who have made a positive contribution to society, or who have dependents more leniently than other offenders. However, to allow these considerations to mitigate penalty potentially licenses offenders to commit crime and decouples the sanction from the severity of the offense, thereby undermining the proportionality principle. This article analyzes the relevance that an offender’s profile should have in sentencing. We conclude that a lack of prior convictions should generally reduce penalty because the empirical data shows that, in relation to most offenses, first-time offenders are less likely to reoffend than recidivist offenders. The situation is more complex in relation to offenders who have made worthy social contributions. They should not be given sentencing credit for past achievements given that past good acts have no relevance to the proper objectives of sentencing and it is normally not tenable, even in a crude sense, to make an informed assessment of an individual’s overall societal contribution. However, offenders should be accorded a sentencing reduction if they have financial or physical dependents and if imprisoning them is likely to cause harm to their dependents. Conferring asentencing discount to first-time offenders and those withdependents does not license them to commit crime or unjustifiablyencroach on the proportionality principle. Rather, it recognizes thedifferent layers of the legal system and the reality that sentencinglaw should not reflexively overwhelm broader maxims of justice,including the principle that innocent people should not suffer. Thisarticle argues that fundamental legislative reform is necessary toproperly reflect the role that the profile of offenders should have inthe sentencing regime.

Cocos Malay language since integration with Australia

The Cocos (Keeling) Islands are a remote Australian territory in the Indian Ocean and arehome to the Cocos Malay people, who have developed a distinct dialect. It waspredicted over 30 years ago that the Cocos Malay language faced extinction, perhapseven within the timeframe of one generation. Two possible threats to the Cocos Malaylanguage were identified. It was felt that English, as the language of power, may replacethe Cocos Malay language. The other possibility was language convergence, whereCocos Malay would be subsumed by another, larger Malay dialect. With these issues inmind, I explore developments in the Cocos Malay language since the Islands’ fullintegration with Australia in 1984. Drawing from extensive ethnographic work andlinguistic research into Cocos Malay I also refer to the work of other researchers toanalyse how the Cocos Malay language has developed over the past 30 years, in a timeof great social change. I argue that integration with Australia and attempts atassimilation have resulted in social dynamics where Cocos Malay language remains adefining marker of Cocos Malay identity positioning. In this social environment, CocosMalay therefore remains viable and, despite language change, does not face immediateextinction.

A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: study protocol.

AIM: To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance. BACKGROUND: Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy. DESIGN: A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods. METHODS: Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012). DISCUSSION: Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.

Assisting Australians with mental health problems and financial difficulties: a Delphi study to develop guidelines for financial counsellors, financial institution staff, mental health professionals and carers

BACKGROUND: There is a strong association between mental health problems and financial difficulties. Therefore, people who work with those who have financial difficulties (financial counsellors and financial institution staff) need to have knowledge and helping skills relevant to mental health problems. Conversely, people who support those with mental health problems (mental health professionals and carers) may need to have knowledge and helping skills relevant to financial difficulties. The Delphi expert consensus method was used to develop guidelines for people who work with or support those with mental health problems and financial difficulties.

METHODS: A systematic review of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions relevant to working with or supporting someone with mental health problems and financial difficulties. These items were rated over three rounds by five Australian expert panels comprising of financial counsellors (n = 33), financial institution staff (n = 54), mental health professionals (n = 31), consumers (n = 20) and carers (n = 24).

RESULTS: A total of 897 items were rated, with 462 items endorsed by at least 80 % of members of each of the expert panels. These endorsed statements were used to develop a set of guidelines for financial counsellors, financial institution staff, mental health professionals and carers about how to assist someone with mental health problems and financial difficulties.

CONCLUSIONS: A diverse group of expert panel members were able to reach substantial consensus on the knowledge, skills and actions needed to work with and support people with mental health problems and financial difficulties. These guidelines can be used to inform policy and practice in the financial and mental health sectors.

The views of parents who experience intergenerational poverty on parenting and play: a qualitative analysis

BACKGROUND: There is minimal literature on how parents experiencing intergenerational poverty view their role as parents and the value they place on children's play. The objective of this study was to examine how these parents view their parenting role and their beliefs about children's play. METHODS: Thirteen mothers of preschool-aged children who experienced intergenerational poverty were recruited to the study. Semi-structured interviews were conducted and were analysed using interpretive phenomenological analysis. RESULTS: Parents described their role as guiding their children to become 'good' people, to teach them skills and provide a routine within the home. There were two disconnections in the data including the view that whilst parenting was hard and lonely, it was also a private matter and participants preferred not to seek support. A second disconnection was in terms of their beliefs about play. Parents believed that whilst play was valuable to their child's development, it was not their role to play with children. However, if parents did play with their child, they noticed positive changes in their child's behaviour. CONCLUSION: The views of parents who experienced intergenerational poverty were similar to other reported findings in parenting studies. However, the current sample differed on not seeking help for support as well as not seeing their role as playing with their children, even though occasions of joining their child in play were associated with a positive change in their relationship with their child. This has implications for communicating about parenting issues with parents who have experienced intergenerational poverty.

Assisting Australians with mental health problems and financial difficulties: a Delphi study to develop guidelines for financial counsellors, financial institution staff, mental health professionals and carers

Background: There is a strong association between mental health problems and financial difficulties. Therefore, people who work with those who have financial difficulties (financial counsellors and financial institution staff) need to have knowledge and helping skills relevant to mental health problems. Conversely, people who support those with mental health problems (mental health professionals and carers) may need to have knowledge and helping skills relevant to financial difficulties. The Delphi expert consensus method was used to develop guidelines for people who work with or support those with mental health problems and financial difficulties. Methods: A systematic review of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions relevant to working with or supporting someone with mental health problems and financial difficulties. These items were rated over three rounds by five Australian expert panels comprising of financial counsellors (n∈=∈33), financial institution staff (n∈=∈54), mental health professionals (n∈=∈31), consumers (n∈=∈20) and carers (n∈=∈24). Results: A total of 897 items were rated, with 462 items endorsed by at least 80 % of members of each of the expert panels. These endorsed statements were used to develop a set of guidelines for financial counsellors, financial institution staff, mental health professionals and carers about how to assist someone with mental health problems and financial difficulties. Conclusions: A diverse group of expert panel members were able to reach substantial consensus on the knowledge, skills and actions needed to work with and support people with mental health problems and financial difficulties. These guidelines can be used to inform policy and practice in the financial and mental health sectors.

Moving images effective teaching with film and television in management

This book will inspire academics, teachers and trainers to use film and television in their classrooms and to shows them how it might be done. It brings together respected international scholars who recount their experiences of how they have used moving images in their classrooms (defined widely to include distance-learning) with their explanations of why they chose this method of teaching and how they put their intentions into action. The book also illustrates how particular subjects might be taught using film and television as an inspiration to demonstrate the range of opportunities that these media offer. Finally, this book considers some of the practical issues in using film and television in the classroom such as copyright, technology, and the representation of reality and drama in films. This is a 'practical, how to' book that answers the questions of those people who have considered using film and television in their classroom but until now have shied away from doing so. The opportunity to see how others have used film effectively breaks down psychological barriers and makes it seem both realistic and worthwhile.

Talking to dogs. Who is listening, what gets said and why does it matter?

This paper is about dogs and stories. As a communication studies academic and owner of a certified therapy dog, I noticed that something interesting happens when people interact with my dog. In some (most) cases, the simple act of patting and talking with the dog triggers the desire to share stories from their own ‘pet history’ – starting with simple catalogue of the animals they have owned, next, moving on to accounts of the life events that have occurred with and because of these pets and finally, sharing how they felt as a result.

Service providers' experiences and needs in working with refugees in the Geelong region: a qualitative study

Service providers in Geelong, one of the priority locations for the resettlement of refugees in regional Australia, were interviewed to explore their perceptions of the health and wellbeing needs of refugees, and the capacity of service providers in a regional area to meet these. In all, 22 interviews were conducted with health and human service professionals in a range of organisations offering refugee-specific services, culturally and linguistically diverse (CALD) services in general, and services to the wider community, including refugees. The findings revealed that a more coordinated approach would increase the effectiveness of existing services; however, the various needs of refugees were more than could be met by organisations in the region at current resource levels. More staff and interpreting services were required, as well as professional development for staff who have had limited experience in working with refugees. It should not be assumed that service needs for refugees resettled in regional Australia will be the same as those of refugees resettled in capital cities. Some services provided in Melbourne were not available in Geelong, and there were services not currently provided to refugees that may be critical in facilitating resettlement in regional and rural Australia.

Co-ingestion of energy drinks with alcohol and other substances among a sample of people who regularly use ecstasy

INTRODUCTION AND AIMS: Despite the potential harms of mixing unregulated drugs with energy drinks (ED), research to date has primarily been focused on EDs co-ingested with alcohol. Consequently, the aim of the present study was to explore the rate of use, harms and correlates of EDs co-ingested with alcohol and other drugs among a sample of people who regularly use illicit stimulant drugs. DESIGN AND METHODS: In 2010, 693 Australians who regularly used ecstasy completed a 1-h interview about their past six-month ED and drug use. RESULTS: Three-quarters of the sample (77%) had recently consumed EDs with other substances, primarily alcohol (70%) and ecstasy (57%). People who consumed ED with alcohol versus those who had consumed ED with ecstasy and with alcohol (only 8% reported only consuming ED with ecstasy) had similar profiles in regards to demographics, drug use, mental health and drug-related problems. Primary motives for consuming ED with alcohol included increased alertness (59%), the taste (25%), to party for longer (23%) and to combat fatigue (16%). One-half (52%) and one-quarter (27%) of participants who consumed EDs with alcohol and with ecstasy respectively had recently experienced adverse outcomes post-consumption, primarily headaches (24% and 11%) and heart palpitations (21% and 14%). DISCUSSION AND CONCLUSIONS: Co-ingestion of EDs with licit and illicit drugs is common among people who regularly use ecstasy and related drugs. Adverse outcomes of co-ingestion suggest that targeted education regarding negative interactive drug effects is crucial for harm reduction. [Peacock A, Sindicich N, Dunn M, Whittaker E, Sutherland R, Entwistle G, Burns L, Bruno R. Co-Ingestion of Energy Drinks with Alcohol and Other Substances among a Sample of People Who Regularly Use Ecstasy. Drug Alcohol Rev 2015].

Assessing communication in people with severe-profound disabilities: co-constructing competence

The recent focus on a human rights agenda in Australia has highlighted the vulnerability of people who have little or no speech in gaining access to their communication rights. This paper discusses the complexities of supporting communication for people with severe–profound disabilities within a framework of human rights. People with severe–profound intellectual disabilities are often considered not only unable to speak, but also unable to communicate. This preconception has been refuted and legislation enacted to protect the communication rights of people with severe–profound disabilities. In this paper we present an overview of good communication practices for people with severe–profound intellectual disabilities. Such practice consists of collaborative and transactional assessment and intervention supports, as exemplified in emerging models of supported and person-centred decision-making.

Compliance with recommendations from a screening programme for diabetic retinopathy

METHODS: General practitioner compliance with recommendations for patient follow-up after participation in a screening programme for diabetic retinopathy was assessed. Six months after screening with non-mydriatic retinal photography in four areas of Victoria, the genera practitioner of each participant was surveyed if the participant reported no examination for diabetic retinopathy in the past 2 years and if the results of the screening indicated the need for further assessment. RESULTS: Overall, 208 of 253 (82%) completed questionnaires were analysed. A total of 123 (59%) patients were referred by their doctors for further assessment and 97 (79%) of those referred were reported to have complied with the referral. Of the 85 (41%) patients who were not referred for further assessment, 31 (36%) were reported by their doctors to be already under regular review by an ophthalmologist. CONCLUSIONS: Compliance with genera practitioner referrals suggests that this screening programme was effective and a useful means by which to remind general practitioners of the importance of regular eye examinations for people with diabetes.

The impact of leisure participation on mental health for older people with depression: a systematic review

Aims: This systematic review aimed to discover whether participation in individually chosen leisure activities improved mental health for people aged over 65 who have depression. Methods: Twenty-six potentially relevant studies were identified from an electronic database review. Of these 12 met the inclusion criteria and scope of the review. Results: The current evidence base is relatively small, and includes a diversity of subject groups, subject situations, and study designs. In all cases, participants were either directed to choose from a number of leisure activities, or provided with a pre-designed program that did not allow for individual choice. Conclusion: Currently, there is insufficient evidence available to determine whether participation in individually chosen leisure activities improves mental health for people aged over 65 who have depression.

Adolescência e infecção pelo HIV : situações de risco e proteção, autoconceito e sintomatologia psiquiátrica

Esta dissertação tem como objetivo identificar, através de um estudo transversal, associações entre as características demográficas, comportamentos de risco sexual e por drogas, sintomatologia psiquiátrica e autoconceito em uma amostra de adolescentes, comparando-os pela soropositividade HIV. Foram entrevistados 388 adolescentes entre 13 e 20 anos que procuraram espontaneamente o Centro de Triagem e Avaliação (CTA) Paulo César Bonfim para realizar o teste anti-HIV. Foram utilizados os questionários CRA (Comportamentos de Risco para AIDS), SCL-90-R (The Symptom Check-List-90-R) e EFA (Escala Fatorial de Autoconceito). A média da idade foi de 17,7 anos (±2,0). A maioria da amostra era do sexo feminino, solteiro ou sem companheiro/a fixo/a, sem trabalho, com baixas escolaridade e renda familiar. Em relação ao teste sorológico, 73% estavam realizandoo pela primeira vez, e a soropositividade geral da amostra foi de 6,2%. A escolaridade foi significativamente mais baixa em soropositivos (OR= 7,8) e não houve diferença estatística entre os grupos nas demais variáveis demográficas. Houve associação direta entre soropositividade e precocidade de início da vida sexual (OR= 3,6), história de gravidez (OR=4,7), prática de aborto prévio (OR= 5,9) e relação sexual com parceiro sem preservativo (OR=3,2). Do total da amostra, 8% dos adolescentes recebeu dinheiro em troca de relação sexual, e isto foi associado à soropositividade (OR=4,5). O mesmo ocorreu nos 13,2% que tiveram relação sexual com paceiro/a possivelmente soropositivo (OR=8,3). Apenas 18,9% da amostra afirmaram usar preservativos nos 6 meses prévios à coleta e 81,4% da amostra não haviam usado preservativo nas relações sexuais ao longo da vida. A prevalência geral de uso de drogas no mês anterior à coleta foi alta, com relato freqüente de uso de múltiplas drogas, sendo as mais freqüentes o álcool (71,6 %), maconha (24,7%), cocaína intranasal (12,4%) e solventes (9,3 %). A soropositividade foi mais alta nos usuários recentes de maconha (OR= 2,8), estimulantes (OR=2,9) e solventes (OR= 7,5). A freqüência a local específico para uso de drogas ocorreu em 22,5% do total da amostra e foi estatisticamente maior nos soropositivos (OR=2,6). Os adolescentes soropositivos apresentaram siginficativamente mais sintomatologia psiquiátrica em todas as dimensões avaliadas. Não houve diferença nas dimensões de autoconceito. O Tamanho de Efeito Padronizado foi maior nas variáveis da sintomatologia psiquiátrica do que nas do autoconceito. Os resultados indicam que os adolescentes estudados ainda não possuem cuidados preventivos suficientes para diminuir o contágio pelo vírus da AIDS. São indivíduos sob risco constante por apresentarem maior freqüência de exposição ao HIV associada à baixa escolaridade, comportamento sexual, uso de drogas e sintomatologia psiquiátrica. A falta de diferenças no autoconceito dos adolescentes soropositivos e soronegativos pode estar associada ao senso de invulnerabilidade próprio da faixa etária. Os achados apontam para a necessidade de programas específicos de prevenção para adolescentes. Medidas de intervenção futuras deverão levar em conta a interação de fatores individuais, ambientais, comportamentais e psicológicos, com o objetivo de implementar mudanças efetivas no comportamento de risco para que se detenha o avanço da epidemia nessa faixa etária.