Development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand

This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand District Health Board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.

An evaluation of a self-intiated practice exercise for investigative interviewers of children

The current study extends debate and research on the important role of practice in promoting and sustaining complex skills in investigative interviewing. Specifically, we explored the use of self-initiated practice as one avenue for facilitating ongoing development of professionals who interview children about abuse. A group of 40 investigative interviewers were required to organise and administer their own practice opportunities and to document these sessions in a diary. The professionals were aware of the important role of practice and what constitutes best-practice interview guidelines; however no instruction was given about the desired format, structure and timing of the practice sessions. A combination of quantitative and qualitative analyses revealed poor adherence to self-initiated practice, and the practice (among those who adhered to this model) had negligible impact on performance. Overall, these findings highlight the need for careful monitoring and evaluation of all interviewer practice tasks.

Knowing practice in English teaching? Research challenges in representing the professional practice of English teachers

This article problematises representations of professional practice. It investigates assumptions behind received accounts of professional practice, including professional standards that purportedly capture what accomplished English teachers “should know and be able to do”, “scientific” studies that construct accounts of classrooms from the standpoint of academic researchers, and narratives written by teachers that claim to explore dimensions of classroom teaching that elude outside observers. Especially significant are attempts by practitioner researchers to develop accounts of their professional practice vis-a-vis constructions of their work from other standpoints. We argue that it is timely for practitioner researchers to reflexively examine the conditions for producing such accounts, and to address the question of the validity of their knowledge claims. Yet this is also – crucially – more than an epistemological issue, but one that requires acknowledging the primacy of practice for engaging with the complexities of classroom settings. This article gives an account of our ongoing efforts to develop forms of representation that might begin to do justice to the complexities of practice in comparison with accepted accounts of what English teachers know and do. We intend it to be read as a position paper which outlines a framework for research on English teaching as a dynamic culture practice.

Deep identity, shallow time : sustaining a future in Victorian fishing communities

Like commercial fishers everywhere, it seems, those living in coastal communities of Victoria perceive themselves to be under threat from recreational fishers, environmentalists, imposed management regimes, and modernisation and globalisation of the industry. In responding to these threats they appeal to conventional props of tradition--to continuity in genealogical time, affiliation with place and specialised knowledge and practice. This seems paradoxical, given that most established fishers in Victoria are first or second generation members of an industry that, through its 150-year history, has been characterised by innovation and mobility. That paradox, we argue, is more apparent than real. Fisher identity is grounded primarily in engagement with an environment that is not familiar to outsiders. The paradox arises because fishers, like others who seek to sustain a future in the face of threat from outsiders, reshape strongly felt identity as tradition.

Understanding the mediatisation of educational policy as practice

The main argument presented in this paper is that the mediatisation of education should be viewed as forms of practice linked to specific practice effects. Drawing on Bourdieu's conceptualisation of practice - as elements of practice, practice games and field effects - the paper argues that viewing mediatisation as practice provides a set of methodological starting points for research involving media interactions with education. Taking the mediatisation of education policy as an empirical case for the argument, the contribution of the paper is to raise questions about how the term is utilised in educational research and to suggest that the practice is more open and complex than some accounts suggest. A secondary argument presented in this paper is that Bourdieu's account of practice provides resources suitable to developing research on mediatisation as an addition to social field theorising of processes.

Practice chains of production and consumption : mediatized practices across social fields

The argument developed in this paper is that a focus on practice provides some resolutions to methodological problems facing Bourdieuian scholarship in education. In order to develop Bourdieu's work on practice to account for the interactions between practices, this paper presents a conceptualization of practice as chains of production and consumption. The first part of the paper reviews the account of practice offered by Bourdieu both embedded in practice games and as field effects. The second part of the paper introduces practice chains of production and consumption as a way to conceptualize practice by drawing on a case involving print journalists' involvement with policy makers over the course of an Australian policy review. The final section presents a discussion of this conceptualization and highlights the potential of the concept for further research in understanding the processes of educational policy development.

Policy, practice and purpose in the field of education : a critical review

This paper provides a critical review of papers in this special issue on Bourdieu and practice. What is different about this collection is that, in analysing policy and practice through a Bourdieusian lens, the thinking tools of field, disposition (collective and individual), logics of practice and doxa have been mobilised with regard to the social practices of educational policy - its production, circulation and reception. First, these papers illustrate how, as a field, education has its own language, boundaries and power relations informed by particular modes of distinction and legitimation around different forms of capital formation, thus providing explanations for both social mobility and social stratification. Second, this collection foregrounds 'policy as practice' in terms of the social practices involved in the production of policy, the practices involved with the articulation and vernacularisation of policy through the processes of its reception, as well as the intent and effects of policy changing practice. Third, in focusing on specific policy problematics in higher education and schools, teacher professional development, leadership and educational reform, these contributions illustrate multiple methodological approaches as to how Bourdieu's thinking tools can be used to theorise educational policy, change, practice and effects. The value of Bourdieu's work lies on getting past the impasses between divisions between material and cultural analyses, between the materialist and linguistic focus, by talking about social practices, what people are doing, how they are thinking and how they are acting.

The TrueBlue study : is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes?

Background: In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD.

Methods: This is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs) will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses.

Conclusion: The strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for physiological, lifestyle and psychological risk factors for high-risk patients with co-morbid depression, diabetes or heart disease. The study will demonstrate whether nurse-led collaborative care achieves better outcomes than usual care.

Emergence of creativity in learning via social technologies

Creativity is an elusive skill desired by many. Debates on 'What is Creativity' and how it can best be nurtured and supported had resurgence in the 1950's after Guildford's address to the American Psychology Association about the positive benefits of creativity. Since then creativity has been investigated in many forms and within many disciplines. Of note is that creativity is apparent within four components: the person, the process, the product and the environment. On some level creativity is assessed within one of the four components of creativity: person, process, product or environment. In this study creativity and the environment is under investigation, with a number of factors presented that allow creativity to be supported. This paper explores the role of creativity within the education of tertiary students studying Games Design and Development (within an IT discipline) from an Australian University. Particularly this paper focuses on how social factors, such as purpose built collaborative environments and virtual communities, aid in the creative pursuits of the students.

The use of heuristics in valuation practice : implications in a changing market

Despite the existence of prescribed frameworks, valuation remains a cause of much controversy and variety of opinion. It does not matter whether procedures are undertaken in exactly the same way, the conclusion of ‘value’ will vary from valuer to valuer – sometimes considerably. This uncertainty within valuation is founded on property’s heterogeneous nature and the imperfect market that is the property market; in addition to the unpredictability of human behaviour in making judgements (French and Gabrielli 2004). Uncertainty, in valuation is found in the amalgam of locational, physical and legal characteristics and innumerable other forces which control and energise the property market (Whipple 1995). Particular irregular occurrences, or drastic changes in property markets, from either within market evolution or external forces, for example the creation of global financial markets, cause further uncertainty for valuers and provides challenges in identifying ‘market value’ in valuation practice. The praxis of valuation in a commercial sense navigates this complexity using a combination of algorithms and heuristics to identify the value of a property. The application of theoretical mathematical algorithms based on economic theory (Brown 1995), is augmented by valuers’ ability to apply appropriate adjustment based on their knowledge of the market, their ability to analyse, assess and compare the attributes of a property in comparison to its market, and their practical experience (Sliogeriene 2008). Despite the necessity of algorithms, the application of appropriate adjustments and assumptions are important in arriving at a value. This paper is a critical reflection on the basis of valuation practice as guided by standards, methods, and ethics (algorithms), and the use of heuristics in practice. This is important because changes within property markets challenge the inter-relationship between these two aspects of valuation practice. Through the authors’ industry experience and a review of previous research and statements of practice norms this paper provides an analysis of the ability of valuers to address market change in their valuation practices.

Practice teaching in the Republic of the Maldives : issues and challenges

Practicum is an important but challenging part of primary teacher education especially in developing countries like the Republic of the Maldives where the effectiveness of practicum can be impeded by geographical distance, isolation, levels of teacher expertise, and by a highly structured system of primary schooling and teacher education. The current paper reports on a study of beginning teachers in their first year of full-time teaching practice and their perceptions of the effectiveness of their practicum experiences during their teacher training both generally and in terms of developing desirable teaching competencies. Teachers reported that their relationship with school and academic staff was one of the most effective and positive features of practice teaching but reported less positively on the processes used to assess and evaluate students during their teaching practice.

Assessment of variation in the alberta context tool : the contribution of unit level contextual factors and practice specialty in Canadian pediatric acute care settings

Background: There are few validated measures of organizational context and none that we located are parsimonious and address modifiable characteristics of context. The Alberta Context Tool (ACT) was developed to meet this need. The instrument assesses 8 dimensions of context, which comprise 10 concepts. The purpose of this paper is to report evidence to further the validity argument for ACT. The specific objectives of this paper are to: (1) examine the extent to which the 10 ACT concepts discriminate between patient care units and (2) identify variables that significantly contribute to between-unit variation for each of the 10 concepts.

Methods: 859 professional nurses (844 valid responses) working in medical, surgical and critical care units of 8 Canadian pediatric hospitals completed the ACT. A random intercept, fixed effects hierarchical linear modeling (HLM) strategy was used to quantify and explain variance in the 10 ACT concepts to establish the ACT’s ability to discriminate between units. We ran 40 models (a series of 4 models for each of the 10 concepts) in which we systematically assessed the unique contribution (i.e., error variance reduction) of different variables to between-unit variation. First, we constructed a null model in which we quantified the variance overall, in each of the concepts. Then we controlled for the contribution of individual level variables (Model 1). In Model 2, we assessed the contribution of practice specialty (medical, surgical, critical care) to variation since it was central to construction of the sampling frame for the study. Finally, we assessed the contribution of additional unit level variables (Model 3).

Results: The null model (unadjusted baseline HLM model) established that there was significant variation between units in each of the 10 ACT concepts (i.e., discrimination between units). When we controlled for individual characteristics, significant variation in the 10 concepts remained. Assessment of the contribution of specialty to between-unit variation enabled us to explain more variance (1.19% to 16.73%) in 6 of the 10 ACT concepts. Finally, when we assessed the unique contribution of the unit level variables available to us, we were able to explain additional variance (15.91% to 73.25%) in 7 of the 10 ACT concepts.

Conclusion: The findings reported here represent the third published argument for validity of the ACT and adds to the evidence supporting its use to discriminate patient care units by all 10 contextual factors. We found evidence of relationships between a variety of individual and unit-level variables that explained much of this between-unit variation for each of the 10 ACT concepts. Future research will include examination of the relationships between the ACT’s contextual factors and research utilization by nurses and ultimately the relationships between context, research utilization, and outcomes for patients.

Excess gestational weight gain : an exploration of midwives' views and practice.

Background
Excess gestational weight gain (GWG) can affect the immediate and long term health outcomes of mother and infant. Understanding health providers' views, attitudes and practices around GWG is crucial to assist in the development of practical, time efficient and cost effective ways of supporting health providers to promote healthy GWGs. This study aimed to explore midwives' views, attitudes and approaches to the assessment, management and promotion of healthy GWG and to investigate their views on optimal interventions.
Methods
Midwives working in antenatal care were recruited from one rural and one urban Australian maternity hospital employing purposive sampling strategies to assess a range of practice areas. Face-to-face interviews were conducted with 15 experienced midwives using an interview guide and all interviews were digitally recorded, transcribed verbatim and analysed thematically.
Results
Midwives interviewed exhibited a range of views, attitudes and practices related to GWG. Three dominant themes emerged. Overall GWG was given low priority for midwives working in the antenatal care service in both hospitals. In addition, the midwives were deeply concerned for the physical and psychological health of pregnant women and worried about perceived negative impacts of discussion about weight and related interventions with women. Finally, the midwives saw themselves as central in providing lifestyle behaviour education to pregnant women and identified opportunities for support to promote healthy GWG.
Conclusions
The findings indicate that planning and implementation of healthy GWG interventions are likely to be challenging because the factors impacting on midwives' engagement in the GWG arena are varied and complex. This study provides insights for guideline and intervention development for the promotion of healthy GWG.

Extending the paramedic role in rural Australia : a story of flexibility and innovation

Introduction: This article identifies trends in the evolving practice of rural paramedics and describes key characteristics, roles and expected outcomes for a Rural Expanded Scope of Practice (RESP) model.

Methods: A multiple case study methodology was employed to examine the evolution of rural paramedic practice. Paramedics, volunteer ambulance officers and other health professionals were interviewed in four rural regions of south-eastern Australia where innovative models of rural paramedic practice were claimed to exist. The research team collected and thematically analysed the data using the filter of a sociological framework throughout 2005 and 2006.

Results: The study found that paramedics are increasingly becoming first line primary healthcare providers in small rural communities and developing additional professional responsibilities throughout the cycle of care.

Conclusions: Adoption of the RESP model would mean that paramedics undertake four broad activities as core components of their new role: (1) rural community engagement; (2) emergency response; (3) situated practice; and (4) primary health care. The model’s key feature is a capacity to integrate existing paramedic models with other health agencies and health professionals to ensure that paramedic care is part of a seamless system that provides patients with well-organized and high quality care. This expansion of paramedics’ scope of practice offers the potential to improve patient care and the general health of rural communities.

Working at the nexus between public health policy, practice and research : dynamics of knowledge sharing in the Netherlands

Background
Joining the domains of practice, research and policy is an important aspect of boosting the quality performance required to tackle complex public health problems. “Joining domains” implies a departure from the linear and technocratic knowledge-translation approach. Integrating the practice, research and policy triangle means knowing its elements, appreciating the barriers, identifying possible cooperation strategies and studying strategy effectiveness under specified conditions.
This article examines the dynamic process of developing an Academic Collaborative Centre for Public Health in the Netherlands, with the objective of achieving that the three domains of policy, practice and research become working partners on an equal footing.
Method
An interpretative hermeneutic approach was used to interpret the phenomenon of collaboration at the nexus between the three domains. The project was explicitly grounded in current organizational culture and routines, applied to nexus action. In the process of examination, we used both quantitative (e.g. records) and qualitative data (e.g., interviews and observations). The data were interpreted using the Actor-Network, Institutional Re-Design and Blurring the Boundaries theories.
Results
Results show commitment at strategic level. At the tactical level, however, managers were inclined to prioritize daily routine, while the policy domain remained absent. At the operational level, practitioners learned to do PhD research in real-life practice and researchers became acquainted with problems of practice and policy, resulting in new research initiatives.
Conclusion
We conclude that working at the nexus is an ongoing process of formation and reformation. Strategies based on Institutional Re-Design theories in particular might help to more actively stimulate managers’ involvement to establish mutually supportive networks.