End-of-life care in the critical care setting : nurses' practices and factors affecting these practices

Background: Critical care units are designed and resourced to save lives, yet the provision of end-of-life care is a significant component of nursing work in these settings. Limited research has investigated the actual practices of critical care nurses in the provision of end-of-life care, or the factors influencing these practices. To improve the care that patients at the end of life and their families receive, and to support nurses in the provision of this care, further research is needed. The purpose of this study was to identify critical care nurses' end-of-life care practices, the factors influencing the provision of end-of-life care and the factors associated with specific end-of-life care practices. Methods: A three-phase exploratory sequential mixed-methods design was utilised. Phase one used a qualitative approach involving interviews with a convenience sample of five intensive care nurses to identify their end-of-life care experiences and practices. In phase two, an online survey instrument was developed, based on a review of the literature and the findings of phase one. The survey instrument was reviewed by six content experts and pilot tested with a convenience sample of 28 critical care nurses (response rate 45%) enrolled in a postgraduate critical care nursing subject. The refined survey instrument was used in phase three of this study to conduct a national survey of critical care nurses. Descriptive analyses, exploratory factor analysis and univariate general linear modelling was undertaken on completed survey responses from 392 critical care nurses (response rate 25%). Results: Six end-of-life care practice areas were identified in this study: information sharing, environmental modification, emotional support, patient and family-centred decision making, symptom management and spiritual support. The items most frequently identified as always undertaken by critical care nurses in the provision of end-of-life care were from the information sharing and environmental modification practice areas. Items least frequently identified as always undertaken included items from the emotional support practice area. Eight factors influencing the provision of end-of-life care were identified: palliative values, patient and family preferences, knowledge, preparedness, organisational culture, resources, care planning, and emotional support for nurses. Strong agreement was noted with items reflecting values consistent with a palliative approach and inclusion of patient and family preferences. Variation was noted in agreement for items regarding opportunities for knowledge acquisition in the workplace and formal education, yet most respondents agreed that they felt adequately prepared. A context of nurse-led practice was identified, with variation in access to resources noted. Collegial support networks were identified as a source of emotional support for critical care nurses. Critical care nurses reporting values consistent with a palliative approach and/or those who scored higher on support for patient and family preferences were more likely to be engaged in end-of-life care practice areas identified in this study. Nurses who reported higher levels of preparedness and access to opportunities for knowledge acquisition were more likely to report engaging in interpersonal practices that supported patient and family centred decision making and emotional support of patients and their families. A negative relationship was identified between the explanatory variables of emotional support for nurses and death anxiety, and the patient and family centred decision making practice area. Contextual factors had a limited influence as explanatory variables of specific end-of-life care practice areas. Gender was identified as a significant explanatory variable in the emotional and spiritual support practice areas, with male gender associated with lower summated scores on these practice scales. Conclusions: Critical care nurses engage in practices to share control with and support inclusion of families experiencing death and dying. The most frequently identified end-of-life care practices were those that are easily implemented, practical strategies aimed at supporting the patient at the end of life and the patient's family. These practices arguably require less emotional engagement by the nurse. Critical care nurses' responses reflected values consistent with a palliative approach and a strong commitment to the inclusion of families in end-of-life care, and these factors were associated with engagement in all end-of-life care practice areas. Perceived preparedness or confidence with the provision of end-of-life care was associated with engagement in interpersonal caring practices. Critical care nurses autonomously engage in the provision of end-of-life care within the constraints of an environment designed for curative care and rely on their colleagues for emotional support. Critical care nurses must be adequately prepared and supported to provide comprehensive care in all areas of end-of-life care practice. The findings of this study raise important implications, and informed recommendations for practice, education and further research.

Analysis and prediction of the critical current density across [001]-tilt YBa2Cu3O7- grain boundaries of arbitrary misorientation angles

A qualitative analysis of the expected dilatation strain field in the vicinity of an array of grain-boundary (GB) dislocations is presented. The analysis provides a basis for the prediction of the critical current densities (jc) across low-angle YBa2Cu3O7- (YBCO) GBs as a function of their energy. The introduction of the GB energy allows the extension of the analysis to high-angle GBs using established models which predict the GB energy as a function of misorientation angle. The results are compared to published data for jc across [001]-tilt YBCO GBs for the full range of misorientations, showing a good fit. Since the GB energy is directly related to the GB structure, the analysis may allow a generalization of the scaling behavior of jc with the GB energy. © 1995 The American Physical Society.

The influence of digital technology on the performance space

Through practice-led research, TESSA SMALLHORN examines the influence of digital technology on the performance space. From the mechanisation of modernist culture to the digitalisation of present day, technology acts as response material for scenographers investigating the stage as machine. The interactive, real-time tools of digital culture encourage a systems-orientated approach that challenges user and operator alike. This article explores the studio practice and critical theory that was combined to offer a functional model of a digital stage machine.

Critical factors for project efficiency in a defence environment

Defence projects are typically undertaken within a multi-project-management environment where a common agenda of project managers is to achieve higher project efficiency. This study adopted a multi-facet qualitative approach to investigate factors contributing to or impeding project efficiency in the Defence sector. Semi-structured interviews were undertaken to identify additional factors to those compiled from the literature survey. This was followed by a three-round Delphi study to examine the perceived critical factors of project efficiency. The results showed that project efficiency in the Defence sector went beyond its traditional internally focused scope to one that is externally focused. As a result, efforts are needed on not only those factors related to individual projects but also those factors related to project inter-dependencies and external customers. The management of these factors will help to enhance the efficiency of a project within the Defence sector.

A new method for quantifying the contribution of different critical agents on railway bridge deterioration

Railway Bridges deteriorate over time due to different critical factors including, flood, wind, earthquake, collision, and environment factors, such as corrosion, wear, termite attack, etc. In current practice, the contributions of the critical factors, towards the deterioration of railway bridges, which show their criticalities, are not appropriately taken into account. In this paper, a new method for quantifying the criticality of these factors will be introduced. The available knowledge as well as risk analyses conducted in different Australian standards and developed for bridge-design will be adopted. The analytic hierarchy process (AHP) is utilized for prioritising the factors. The method is used for synthetic rating of railway bridges developed by the authors of this paper. Enhancing the reliability of predicting the vulnerability of railway bridges to the critical factors, will be the significant achievement of this research.

Promoting a more positive traffic safety culture in Australia : lessons learnt and future directions

Adopting a traffic safety culture approach, this paper identifies and discusses the ongoing challenge of promoting the road safety message in Australia. It is widely acknowledged that mass media and public education initiatives have played a critical role in the significant positive changes witnessed in community attitudes to road safety in the last three to four decades. It could be argued that mass media and education have had a direct influence on behaviours and attitudes, as well as an indirect influence through signposting and awareness raising functions in conjunction with enforcement. Great achievements have been made in reducing fatalities on Australia’s roads; a concept which is well understood among the international road safety fraternity. How well these achievements are appreciated by the general Australian community however, is not clear. This paper explores the lessons that can be learnt from successes in attitudinal and behaviour change in regard to seatbelt use and drink driving in Australia. It also identifies and discusses key challenges associated with achieving further positive changes in community attitudes and behaviours, particularly in relation to behaviours that may not be perceived by the community as dangerous, such as speeding and mobile phone use while driving. Potential strategies for future mass media and public education campaigns to target these challenges are suggested, including ways of harnessing the power of contemporary traffic law enforcement techniques, such as point-to-point speed enforcement and in-vehicle technologies, to help spread the road safety message.

2 Hour game jam at SLQ Garage Gamer - Live performance with crowd participation

The 2 hour game jam was performed as part of the State Library of Queensland 'Garage Gamer' series of events, summer 2013, at the SLQ exhibition. An aspect of the exhibition was the series of 'Level Up' game nights. We hosted the first of these - under the auspices of brIGDA, Game On. It was a party - but the focal point of the event was a live streamed 2 hour game jam. Game jams have become popular amongst the game development and design community in recent years, particularly with the growth of the Global Game Jam, a yearly event which brings thousands of game makers together across different sites in different countries. Other established jams take place on-line, for example the Ludum Dare challenge which as been running since 2002. Other challenges follow the same model in more intimate circumstances and it is now common to find institutions and groups holding their own small local game making jams. There are variations around the format, some jams are more competitive than others for example, but a common aspect is the creation of an intense creative crucible centred around team work and ‘accelerated game development’. Works (games) produced during these intense events often display more experimental qualities than those undertaken as commercial projects. In part this is because the typical jam is started with a conceptual design brief, perhaps a single word, or in the case of the specific game jam described in this paper, three words. Teams have to envision the challenge key word/s as a game design using whatever skills and technologies they can and produce a finished working game in the time given. Game jams thus provide design researchers with extraordinary fodder and recent years have also seen a number of projects which seek to illuminate the design process as seen in these events. For example, Gaydos, Harris and Martinez discuss the opportunity of the jam to expose students to principles of design process and design spaces (2011). Rouse muses on the game jam ‘as radical practice’ and a ‘corrective to game creation as it is normally practiced’. His observations about his own experience in a jam emphasise the same artistic endeavour forefronted earlier, where the experience is about creation that is divorced from the instrumental motivations of commercial game design (Rouse 2011) and where the focus is on process over product. Other participants remark on the social milieu of the event as a critical factor and the collaborative opportunity as a rich site to engage participants in design processes (Shin et al, 2012). Shin et al are particularly interested in the notion of the site of the process and the ramifications of participants being in the same location. They applaud the more localized event where there is an emphasis on local participation and collaboration. For other commentators, it is specifically the social experience in the place of the jam is the most important aspect (See Keogh 2011), not the material site but rather the physical embodied experience of ‘being there’ and being part of the event. Participants talk about game jams they have attended in a similar manner to those observations made by Dourish where the experience is layered on top of the physical space of the event (Dourish 2006). It is as if the event has taken on qualities of place where we find echoes of Tuan’s description of a particular site having an aura of history that makes it a very different place, redolent and evocative (Tuan 1977). The 2 hour game jam held during the SLQ Garage Gamer program was all about social experience.

Methodological developments in phenomenography : investing using information to learn in the discipline classroom

This paper discusses methodological developments in phenomenography that make it apropos for the study of teaching and learning to use information in educational environments. Phenomenography is typically used to analyze interview data to determine different ways of experiencing a phenomenon. There is an established tradition of phenomenographic research in the study of information literacy (ex: Bruce, 1997; 2008; Lupton, 2008; Webber, Boon, & Johnston, 2005). Drawing from the large body of evidence complied in two decades of research, phenomenographers developed variation theory, which explains what a learner can feasibly learn from a classroom lesson based on how the phenomenon being studied is presented (Marton, Runesson, & Tsui, 2004). Variation theory’s ability to establish the critical conditions necessary for learning to occur has resulted in the use of phenomenographic methods to study classroom interactions by collecting and analyzing naturalistic data through observation, as well as interviews concerning teachers’ intentions and students’ different experiences of classroom lessons. Describing the methodological developments of phenomenography in relation to understanding the classroom experience, this paper discusses the potential benefits and challenges of utilizing such methods to research the experiences of teaching and learning to use information in discipline-focused classrooms. The application of phenomenographic methodology for this purpose is exemplified with an ongoing study that explores how students learned to use information in an undergraduate language and gender course (Maybee, Bruce, Lupton, & Rebmann, in press). This paper suggests that by providing a nuanced understanding of what is intended for students to learn about using information, and relating that to what transpires in the classroom and how students experience these lessons, phenomenography and variation theory offer a viable framework for further understanding and improving how students are taught, and learn to use information.

Artscience in practice : exploring the critical and creative potentials of transdisciplinary art and science practice using a methodological and conceptual framework of creative becoming

In response to a growing interest in art and science interactions and transdisciplinary research strategies, this research project examines the critical and conceptual affordances of ArtScience practice and outlines a new experiential methodology for practice-lead research using a framework of creative becoming. In doing so, the study contributes to the field of ArtScience and transdisciplinary practice, by providing new strategies for creative development and critical enquiry across art and science.

Capturing the 'authentic voice' : challenges and opportunities for voice and self-representation in two ABC storytelling projects

In recent years there has been a noticeable move by various public institutions, such as public service broadcasters and community media organisations, to capture and disseminate the voices and viewpoints of ‘ordinary people’ through inviting them to share stories about their lives. One of the foremost objectives of many such projects is to provide under-represented individuals and groups with an opportunity to express and represent themselves; as such, the capture and broadcast of ‘authentic voices’ is a central value. This paper discusses the notion of ‘authentic voice’, and questions the framing role of public media organisations in storytelling projects that aim to provide individuals with space for self-expression and self-representation. It considers the ways in which tensions arise on multiple levels when individuals are asked to express and represent themselves within projects and spaces that are managed by institutions. This paper begins by discussing the challenges and opportunities that arise within storytelling projects that are facilitated by public institutions and community media arts organisations, and that aim to amplify the voices of “ordinary people” (Thumim, 2009). It examines ways in which ‘voice’ is facilitated, curated, broadcast and distributed within such projects, particularly questioning the ways in which project facilitation and the curation of stories for public broadcast can both help and hinder the amplification of ‘authentic voice’. Furthermore, we seek to discuss how ‘authentic voice’ is defined, and what is involved in the process of amplification. The paper moves on to discuss a case study in order to demonstrate some of the tensions that are evident within a storytelling project that is managed by a public institution – Australia’s national broadcaster – and the ways these tensions impact upon the capture and broadcast of an ‘authentic voice’ for project participants. The Australian Broadcasting Corporation’s (ABC) ‘Heywire’ project is a storytelling competition and website that aims to ‘give voice’ to 16-22 year olds who live in rural, regional and remote parts of Australia. Looking at tensions that exist on organisational, political and philosophical levels within the Heywire project reveals a number of conflicts of interest and objectives between the institution and project participants. This leads us to question whether institutionally-managed storytelling projects can effectively support individuals to have an ‘authentic voice’, and whether struggles of aims and objectives diminish the personal benefits that people may derive from expressing and representing themselves within such projects.

Road safety in Australia : successes, challenges for the future, and possibilities for the USA

Overview - Role of CARRS-Q - Australia’s road safety performance - Key features of Australia’s approach to road safety: - Strong reliance on traffic law enforcement, supported by mass media public education - Adoption of the Safe Systems approach - Ambitious road trauma reduction targets? - Ongoing challenges - Possibilities for the USA

A critical realist perspective of enterprise architecture evolution : preliminary findings

This paper investigates how Enterprise Architecture (EA) evolves due to emerging trends. It specifically explores how EA integrates the Service-oriented Architecture (SOA). Archer’s Morphogenetic theory is used as an analytical approach to distinguish the architectural conditions under which SOA is introduced, to study the relationships between these conditions and SOA introduction, and to reflect on EA evolution (elaborations) that then take place. The paper focuses on reasons for why EA evolution could take place, or not and what architectural changes could happen due to SOA integration. The research builds on sound theoretical foundations to discuss EA evolution in a field that often lacks a solid theoretical groundwork. Specifically, it proposes that critical realism, using the morphogenetic theory, can provide a useful theoretical foundation to study enterprise architecture (EA) evolution. The initial results of a literature review (a-priori model) were extended using explorative interviews. The findings of this study are threefold. First, there are five different levels of EA-SOA integration outcomes. Second, a mature EA, flexible and well-defined EA framework and comprehensive objectives of EA improve the integration outcomes. Third, the analytical separation using Archer’s theory is helpful in order to understand how these different integration outcomes are generated.

Predicting crack initiation due to ratchetting in rail heads using critical element analysis

This paper presents a strategy to predict the lifetime of rails subjected to large rolling contact loads that induce ratchetting strains in the rail head. A critical element concept is used to calculate the number of loading cycles needed for crack initiation to occur in the rail head surface. In this technique the finite element method (FEM) is used to determine the maximum equivalent ratchetting strain per load cycle, which is calculated by combining longitudinal and shear stains in the critical element. This technique builds on a previously developed critical plane concept that has been used to calculate the number of cycles to crack initiation in rolling contact fatigue under ratchetting failure conditions. The critical element concept simplifies the analytical difficulties of critical plane analysis. Finite element analysis (FEA) is used to identify the critical element in the mesh, and then the strain values of the critical element are used to calculate the ratchetting rate analytically. Finally, a ratchetting criterion is used to calculate the number of cycles to crack initiation from the ratchetting rate calculated.

Using GPS and accelerometry to assess older adults' driving behaviours and performance : challenges and future directions

With the projected increase in older adults, the older driver population is estimated to be the fastest growing cohort of drivers among many developed countries. The increased physical fragility associated with the aging process make older adults who drive private automobiles a vulnerable road user group. Much of the current research on older drivers’ behaviours and practices rely on self-report data. This paper explores the utility of in-vehicle devices (Global Positioning Systems and recording accelerometers) in assessing older drivers’ habitual driving behaviours. Seventy-eight older drivers (above 65 years of age), from the Australian Capital Territory, Australia, participated in the current study. The driving behaviours and practices of these participants were prospectively assessed over a two-week period. The use of combined GPS and recording accelerometers to improve understanding of older drivers’ driving behaviours show promise within the current study. The challenges of using multiple in-vehicle devices in assessing driving beahaviours and performances within this cohort will be discussed. Based on the current findings, recommendations for future research regarding the use of in-vehicle devices among the older driver cohort are proposed.

A grand challenge : reflecting on university science curriculum design, collaborative partnerships and integration of information literacy skills

In 2012, Queensland University of Technology (QUT) committed to the massive project of revitalizing its Bachelor of Science (ST01) degree. Like most universities in Australia, QUT has begun work to align all courses by 2015 to the requirements of the updated Australian Qualifications Framework (AQF) which is regulated by the Tertiary Education Quality and Standards Agency (TEQSA). From the very start of the redesigned degree program, students approach scientific study with an exciting mix of theory and highly topical real world examples through their chosen “grand challenge.” These challenges, Fukushima and nuclear energy for example, are the lenses used to explore science and lead to 21st century learning outcomes for students. For the teaching and learning support staff, our grand challenge is to expose all science students to multidisciplinary content with a strong emphasis on embedding information literacies into the curriculum. With ST01, QUT is taking the initiative to rethink not only content but how units are delivered and even how we work together between the faculty, the library and learning and teaching support. This was the desired outcome but as we move from design to implementation, has this goal been achieved? A main component of the new degree is to ensure scaffolding of information literacy skills throughout the entirety of the three year course. However, with the strong focus on problem-based learning and group work skills, many issues arise both for students and lecturers. A move away from a traditional lecture style is necessary but impacts on academics’ workload and comfort levels. Therefore, academics in collaboration with librarians and other learning support staff must draw on each others’ expertise to work together to ensure pedagogy, assessments and targeted classroom activities are mapped within and between units. This partnership can counteract the tendency of isolated, unsupported academics to concentrate on day-to-day teaching at the expense of consistency between units and big picture objectives. Support staff may have a more holistic view of a course or degree than coordinators of individual units, making communication and truly collaborative planning even more critical. As well, due to staffing time pressures, design and delivery of new curriculum is generally done quickly with no option for the designers to stop and reflect on the experience and outcomes. It is vital we take this unique opportunity to closely examine what QUT has and hasn’t achieved to be able to recommend a better way forward. This presentation will discuss these important issues and stumbling blocks, to provide a set of best practice guidelines for QUT and other institutions. The aim is to help improve collaboration within the university, as well as to maximize students’ ability to put information literacy skills into action. As our students embark on their own grand challenges, we must challenge ourselves to honestly assess our own work.