Under the carpet : the politics and trauma of patient harm

Few studies have investigated iatrogenic outcomes from the viewpoint of patient experience. To address this anomaly, the broad aim of this research is to explore the lived experience of patient harm. Patient harm is defined as major harm to the patient, either psychosocial or physical in nature, resulting from any aspect of health care. Utilising the method of Consensual Qualitative Research (CQR), in-depth interviews are conducted with twenty-four volunteer research participants who self-report having been severely harmed by an invasive medical procedure. A standardised measure of emotional distress, the Impact of Event Scale (IES), is additionally employed for purposes of triangulation. Thematic analysis of transcript data indicate numerous findings including: (i) difficulties regarding patients‘ prior understanding of risks involved with their medical procedure; (ii) the problematic response of the health system post-procedure; (iii) multiple adverse effects upon life functioning; (iv) limited recourse options for patients; and (v) the approach desired in terms of how patient harm should be systemically handled. In addition, IES results indicate a clinically significant level of distress in the sample as a whole. To discuss findings, a cross-disciplinary approach is adopted that draws upon sociology, medicine, medical anthropology, psychology, philosophy, history, ethics, law, and political theory. Furthermore, an overall explanatory framework is proposed in terms of the master themes of power and trauma. In terms of the theme of power, a postmodernist analysis explores the politics of patient harm, particularly the dynamics surrounding the politics of knowledge (e.g., notions of subjective versus objective knowledge, informed consent, and open disclosure). This analysis suggests that patient care is not the prime function of the health system, which appears more focussed upon serving the interests of those in the upper levels of its hierarchy. In terms of the master theme of trauma, current understandings of posttraumatic stress disorder (PTSD) are critiqued, and based on data from this research as well as the international literature, a new model of trauma is proposed. This model is based upon the principle of homeostasis observed in biology, whereby within every cell or organism a state of equilibrium is sought and maintained. The proposed model identifies several bio-psychosocial markers of trauma across its three main phases. These trauma markers include: (i) a profound sense of loss; (ii) a lack of perceived control; (iii) passive trauma processing responses; (iv) an identity crisis; (v) a quest to fully understand the trauma event; (vi) a need for social validation of the traumatic experience; and (vii) posttraumatic adaption with the possibility of positive change. To further explore the master themes of power and trauma, a natural group interview is carried out at a meeting of a patient support group for arachnoiditis. Observations at this meeting and members‘ stories in general support the homeostatic model of trauma, particularly the quest to find answers in the face of distressing experience, as well as the need for social recognition of that experience. In addition, the sociopolitical response to arachnoiditis highlights how public domains of knowledge are largely constructed and controlled by vested interests. Implications of the data overall are discussed in terms of a cultural revolution being needed in health care to position core values around a prime focus upon patients as human beings.

Applying a social justice framework to ensure good practice in monitoring student learning engagement

A current Australian Learning and Teaching Council (ALTC) funded action research project aims to provide a set of practical resources founded on a social justice framework, to guide good practice for monitoring student learning engagement (MSLE) in higher education. The project involves ten Australasian institutions, eight of which are engaged in various MSLE type projects. A draft framework, consisting of six social justice principles which emerged from the literature has been examined with reference to the eight institutional approaches for MSLE in conjunction with the personnel working on these initiatives during the first action research cycle. The cycle will examine the strategic and operational implications of the framework in each of the participating institutions. Cycle 2 will also build capacity to embed the principles within the institutional MSLE program and will identify and collect examples and resources that exemplify the principles in practice. The final cycle will seek to pilot the framework to guide new MSLE initiatives. In its entirety, the project will deliver significant resources to the sector in the form of a social justice framework for MSLE, guidelines and sector exemplars for MSLE. As well as increasing the awareness amongst staff around the criticality of transition to university (thereby preventing attrition) and the significance of the learning and teaching agenda in enhancing student engagement, the project will build leadership capacity within the participating institutions and provide a knowledge base and institutional capacity for the Australasian HE sector to deploy the deliverables that will safeguard student learning engagement At this early stage of the project the workshop session provides an opportunity to discuss and examine the draft set of social justice principles and to discuss their potential value for the participants’ institutional contexts. Specifically, the workshop will explore critical questions associated with the principles.

Psychosocial predictors of rule following in hostels for women experiencing homelessness

This study examined the psychosocial factors impacting upon the rule-following behaviour of residents of a hostel providing crisis accommodation to women who are homeless. After their arrival, residents of a women’s hostel (N = 83) completed questionnaires assessing the Theory of Planned Behaviour constructs of attitude, subjective norm, perceived behavioural control (PBC), and intentions related to rule-following while residing at the hostel. Perceived resident group norms for rule-following were assessed also. Follow-up staff evaluations of the target behaviour were completed after participants ceased their hostel residence. As expected, attitude, subjective norm, PBC, and group norm significantly predicted intention to follow hostel rules, and intention and PBC predicted rule following behaviour. As rule following is a crucial requirement for continuation of their stay, these findings can inform strategies to improve the experiences and outcomes of women’s short-term hostel stays.

A Popperian consilience : modelling mathematical knowledge and understanding

Goldin (2003) and McDonald, Yanchar, and Osguthorpe (2005) have called for mathematics learning theory that reconciles the chasm between ideologies, and which may advance mathematics teaching and learning practice. This paper discusses the theoretical underpinnings of a recently completed PhD study that draws upon Popper’s (1978) three-world model of knowledge as a lens through which to reconsider a variety of learning theories, including Piaget’s reflective abstraction. Based upon this consideration of theories, an alternative theoretical framework and complementary operational model was synthesised, the viability of which was demonstrated by its use to analyse the domain of early-number counting, addition and subtraction.

Reshaping Doctoral Education : International Approaches and Pedagogies

The number of doctorates being awarded around the world has almost doubled over the last ten years, propelling it from a small elite enterprise into a large and ever growing international market. Within the context of increasing numbers of doctoral students this book examines the new doctorate environment and the challenges it is starting to face. Drawing on research from around the world the individual authors contribute to a previously under-represented focus of theorising the emerging practices of doctoral education and the shape of change in this arena. Key aspects, expertly discussed by contributors from the UK, USA, Australia, New Zealand, China, South Africa, Sweden and Denmark include: -the changing nature of doctoral education -the need for systematic and principled accounts of doctoral pedagogies -the importance of disciplinary specificity -the relationship between pedagogy and knowledge generation -issues of transdisciplinarity. Reshaping Doctoral Education provides rich accounts of traditional and more innovative pedagogical practices within a range of doctoral systems in different disciplines, professional fields and geographical locations, providing the reader with a trustworthy and scholarly platform from which to design the doctoral experience. It will prove an essential resource for anyone involved in doctorate studies, whether as students, supervisors, researchers, administrators, teachers or mentors.

The influence of conformity and group identity on drink walking intentions : comparing intentions to drink walk across risky pedestrian crossing scenarios

Despite the dangers associated with drink walking, limited research is currently available regarding the factors which influence individuals to engage in this risky behaviour. This study examined the influence of psychosocial factors upon individuals’ intentions to drink walk across four experimental scenarios (and a control condition). Specifically, a 2 × 2 repeated measures design was utilised in which all of the scenarios incorporated a risky pedestrian crossing situation (i.e., a pedestrian crossing against a red man signal) but differed according to the level of group identity (i.e., low/strangers and high/friends) and conformity (low and high). Individuals were assessed for their intentions to drink walk within each of these different scenarios. Undergraduate students (N = 151), aged 17–30 years, completed a questionnaire. Overall, most of the study's hypotheses were supported with individuals reporting the highest intentions to drink walk when in the presence of friends (i.e., high group identity) and their friends were said to be also crossing against the red man signal (i.e., high conformity). The findings may have significant implications for the design of countermeasures to reduce drink walking. For instance, the current findings would suggest that potentially effective strategies may be to promote resilience to peer influence as well as highlight the negative consequences associated with following the behaviour of other intoxicated pedestrians who are crossing against a red signal.

Exploring intercultural competence : a service-learning approach

This study explored the developing intercultural competence of fourth-year Australian education pre-service teachers through a core unit of study on inclusive education, following a service-learning pathway. The Australian pre-service teachers volunteered to be 'of service' to a cohort of second-year Malaysian pre-service teachers studying in Australia in a transnational twinning program. Students participated in a Patches program which included writing 'patches' (reflections) and engaging in social exchanges. Data were gathered from focus group interviews, written reflection logs and Patches writing books and were analysed through Butin's (2005) four-lenses of service-learning: technical, cultural, political and post-modern lenses. Data revealed that initially the Australian pre-service teachers felt their presumptions but by the end of the semester embraced the basic tenants of inclusion and were able to project how they could take their new understandings into the classroom as inclusive teachers.

An improved genetic algorithm and graph theory based method for optimal sectionalizer switch placement in distribution networks with DG

In this paper a new graph-theory and improved genetic algorithm based practical method is employed to solve the optimal sectionalizer switch placement problem. The proposed method determines the best locations of sectionalizer switching devices in distribution networks considering the effects of presence of distributed generation (DG) in fitness functions and other optimization constraints, providing the maximum number of costumers to be supplied by distributed generation sources in islanded distribution systems after possible faults. The proposed method is simulated and tested on several distribution test systems in both cases of with DG and non DG situations. The results of the simulations validate the proposed method for switch placement of the distribution network in the presence of distributed generation.

Business process management : theory on progression and maturity

Business Process Management (BPM) is a topic that continues to grow in significance as organisations seek to gain and sustain competitive advantage in an increasingly global environment. Despite anecdotal evidence of organisations improving performance by pursuing a BPM approach, there is little theory that explains and substantiates this relationship. This study provides the first theory on the progression and maturity of BPM Initiatives within organisations and provides a vital starting block upon which future research in this area can build. The Researcher starts by clearly defining three key terms (BPM Initiative, BPM Progression and BPM Maturity), showing the relationship between these three concepts and proposing their relationship with Organisational Performance. The Researcher then combines extant literature and use of the Delphi Technique and the case study method to explore the progression and measurement of the BPM Initiatives within organisations. The study builds upon the principles of general theories including the Punctuated Equilibrium Model and Dynamic Capabilities to present theory on BPM Progression and BPM Maturity. Using the BPM Capability Framework developed through an international Delphi study series, the Researcher shows how the specific organisational context influences which capability areas an organisation chooses to progress. By comparing five separate organisations over an extended time the Researcher is able to show that, despite this disparity, there is some evidence of consistency with regard to the capability areas progressed. This suggests that subsequent identification of progression paths may be possible. The study also shows that the approach and scope taken to BPM within each organisation is a likely predictor of such paths. These outcomes result in the proposal of a formative model for measuring BPM Maturity.

A preliminary theory of dark network resilience

A crucial contemporary policy question for governments across the globe is how to cope with international crime and terrorist networks. Many such “dark” networks—that is, networks that operate covertly and illegally—display a remarkable level of resilience when faced with shocks and attacks. Based on an in-depth study of three cases (MK, the armed wing of the African National Congress in South Africa during apartheid; FARC, the Marxist guerrilla movement in Colombia; and the Liberation Tigers of Tamil Eelam, LTTE, in Sri Lanka), we present a set of propositions to outline how shocks impact dark network characteristics (resources and legitimacy) and networked capabilities (replacing actors, linkages, balancing integration and differentiation) and how these in turn affect a dark network's resilience over time. We discuss the implications of our findings for policymakers.

High fidelity simulation; challenges encountered in developing and implementing student learning experiences, staff education and researching approaches to learning

High fidelity simulation as a teaching and learning approach is being embraced by many schools of nursing. Our school embarked on integrating high fidelity (HF) simulation into the undergraduate clinical education program in 2011. Low and medium fidelity simulation has been used for many years, but this did not simplify the integration of HF simulation. Alongside considerations of how and where HF simulation would be integrated, issues arose with: student consent and participation for observed activities; data management of video files; staff development, and conceptualising how methods for student learning could be researched. Simulation for undergraduate student nurses commenced as a formative learning activity, undertaken in groups of eight, where four students undertake the ‘doing’ role and four are structured observers, who then take a formal role in the simulation debrief. Challenges for integrating simulation into student learning included conceptualising and developing scenarios to trigger students’ decision making and application of skills, knowledge and attitudes explicit to solving clinical ‘problems’. Developing and planning scenarios for students to ‘try out’ skills and make decisions for problem solving lay beyond choosing pre-existing scenarios inbuilt with the software. The supplied scenarios were not concept based but rather knowledge, skills and technology (of the manikin) focussed. Challenges lay in using the technology for the purpose of building conceptual mastery rather than using technology simply because it was available. As we integrated use of HF simulation into the final year of the program, focus was on building skills, knowledge and attitudes that went beyond technical skill, and provided an opportunity to bridge the gap with theory-based knowledge that students often found difficult to link to clinical reality. We wished to provide opportunities to develop experiential knowledge based on application and clinical reasoning processes in team environments where problems are encountered, and to solve them, the nurse must show leadership and direction. Other challenges included students consenting for simulations to be videotaped and ethical considerations of this. For example if one student in a group of eight did not consent, did this mean they missed the opportunity to undertake simulation, or that others in the group may be disadvantaged by being unable to review their performance. This has implications for freely given consent but also for equity of access to learning opportunities for students who wished to be taped and those who did not. Alongside this issue were the details behind data management, storage and access. Developing staff with varying levels of computer skills to use software and undertake a different approach to being the ‘teacher’ required innovation where we took an experiential approach. Considering explicit learning approaches to be trialled for learning was not a difficult proposition, but considering how to enact this as research with issues of blinding, timetabling of blinded groups, and reducing bias for testing results of different learning approaches along with gaining ethical approval was problematic. This presentation presents examples of these challenges and how we overcame them.

Dichotomy in the design studio : adapting to new blended learning environments

In a study aimed at better understanding how staff and students adapt to new blended studio learning environments (BSLE’s), a group of 165 second year architecture students at a large school of architecture in Australia were separated into two different design studio learning environments. 70% of students were allocated to a traditional studio design learning environment (TSLE) and 30% to a new, high technology embedded, prototype digital learning laboratory. The digital learning laboratory was purpose designed for the case-study users, adapted Student-Centred Active Learning Environment for Undergraduate Programs (SCALE-UP) principles, and built as part of a larger university research project. The architecture students attended the same lectures, followed the same studio curriculum and completed the same pieces of assessment; the only major differences were the teaching staff and physical environment within which the studios were conducted. At the end of the semester, the staff and students were asked to complete a questionnaire about their experiences and preferences within the two respective learning environments. Following this, participants were invited to participate in focus groups, where a synergistic approach was effected. Using a dual method qualitative approach, the questionnaire and survey data were coded and extrapolated using both thematic analysis and grounded theory methodology. The results from these two different approaches were compared, contrasted and finally merged, to reveal six distinct emerging themes, which were instrumental in offering resistance or influencing adaptation to, the new BLSE. This paper reports on the study, discusses the major contributors to negative resistance and proposes points for consideration, when transitioning from a TSLE to a BLSE.

A multidisciplinary examination of fast bowling talent development in cricket

Research on expertise, talent identification and development has tended to be mono-disciplinary, typically adopting geno-centric or environmentalist positions, with an overriding focus on operational issues. In this thesis, the validity of dualist positions on sport expertise is evaluated. It is argued that, to advance understanding of expertise and talent development, a shift towards a multidisciplinary and integrative science focus is necessary, along with the development of a comprehensive multidisciplinary theoretical rationale. Dynamical systems theory is utilised as a multidisciplinary theoretical rationale for the succession of studies, capturing how multiple interacting constraints can shape the development of expert performers. Phase I of the research examines experiential knowledge of coaches and players on the development of fast bowling talent utilising qualitative research methodology. It provides insights into the developmental histories of expert fast bowlers, as well as coaching philosophies on the constraints of fast bowling expertise. Results suggest talent development programmes should eschew the notion of common optimal performance models and emphasize the individual nature of pathways to expertise. Coaching and talent development programmes should identify the range of interacting constraints that impinge on the performance potential of individual athletes, rather than evaluating current performance on physical tests referenced to group norms. Phase II of this research comprises three further studies that investigate several of the key components identified as important for fast bowling expertise, talent identification and development extrapolated from Phase I of this research. This multidisciplinary programme of work involves a comprehensive analysis of fast bowling performance in a cross-section of the Cricket Australia high performance pathways, from the junior, emerging and national elite fast bowling squads. Briefly, differences were found in trunk kinematics associated with the generation of ball speed across the three groups. These differences in release mechanics indicated the functional adaptations in movement patterns as bowlers’ physical and anatomical characteristics changed during maturation. Second to the generation of ball speed, the ability to produce a range of delivery types was highlighted as a key component of expertise in the qualitative phase. The ability of athletes to produce consistent results on different surfaces and in different environments has drawn attention to the challenge of measuring consistency and flexibility in skill assessments. Examination of fast bowlers in Phase II demonstrated that national bowlers can make adjustments to the accuracy of subsequent deliveries during performance of a cricket bowling skills test, and perform a range of delivery types with increased accuracy and consistency. Finally, variability in selected delivery stride ground reaction force components in fast bowling revealed the degenerate nature of this complex multi-articular skill where the same performance outcome can be achieved with unique movement strategies. Utilising qualitative and quantitative methodologies to examine fast bowling expertise, the importance of degeneracy and adaptability in fast bowling has been highlighted alongside learning design that promotes dynamic learning environments.