The impact of a model of nurse education to improve knowledge and recognition of delirium in older persons by registered nurses

Introduction: Delirium is a serious issue associated with high morbidity and mortality in older hospitalised people. Early recognition enables diagnosis and treatment of underlying cause/s, which can lead to improved patient outcomes. However, research shows knowledge and accurate nurse recognition of delirium and is poor and lack of education appears to be a key issue related to this problem. Thus, the purpose of this randomised controlled trial (RCT) was to evaluate, in a sample of registered nurses, the usability and effectiveness of a web-based learning site, designed using constructivist learning principles, to improve acute care nurse knowledge and recognition of delirium. Prior to undertaking the RCT preliminary phases involving; validation of vignettes, video-taping five of the validated vignettes, website development and pilot testing were completed. Methods: The cluster RCT involved consenting registered nurse participants (N = 175) from twelve clinical areas within three acute health care facilities in Queensland, Australia. Data were collected through a variety of measures and instruments. Primary outcomes were improved ability of nurses to recognise delirium using written validated vignettes and improved knowledge of delirium using a delirium knowledge questionnaire. The secondary outcomes were aimed at determining nurse satisfaction and usability of the website. Primary outcome measures were taken at baseline (T1), directly after the intervention (T2) and two months later (T3). The secondary outcomes were measured at T2 by participants in the intervention group. Following baseline data collection remaining participants were assigned to either the intervention (n=75) or control (n=72) group. Participants in the intervention group were given access to the learning intervention while the control group continued to work in their clinical area and at that time, did not receive access to the learning intervention. Data from the primary outcome measures were examined in mixed model analyses. Results: Overall, the effect of the online learning intervention over time comparing the intervention group and the control group were positive. The intervention groups‘ scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for delirium recognition when comparing T2 and T1 results (t=2.58 p=0.012) between the control and intervention group but not for changes in delirium recognition scores between the two groups from T3 and T1 (t=1.80 p=0.074). The majority of the participants rated the website highly on the visual, functional and content elements. Additionally, nearly 80% of the participants liked the overall website features and there were self-reported improvements in delirium knowledge and recognition by the registered nurses in the intervention group. Discussion: Findings from this study support the concept that online learning is an effective and satisfying method of information delivery. Embedded within a constructivist learning environment the site produced a high level of satisfaction and usability for the registered nurse end-users. Additionally, the results showed that the website significantly improved delirium knowledge & recognition scores and the improvement in delirium knowledge was retained at a two month follow-up. Given the strong effect of the intervention the online delirium intervention should be utilised as a way of providing information to registered nurses. It is envisaged that this knowledge would lead to improved recognition of delirium as well as improvement in patient outcomes however; translation of this knowledge attainment into clinical practice was outside the scope of this study. A critical next step is demonstrating the effect of the intervention in changing clinical behaviour, and improving patient health outcomes.

The Australian screen producer: Understanding screen production cultures in a period of industrial transition [Abstract]

The screen producer plays a vital role in shaping the creative, commercial and entrepreneurial dimensions of production. And yet Australian film history is most often presented as an appreciation of film directors or an examination of industrial governance measures. On the other hand, public funding agencies in Australia have, for the most part, supported independent film and television production as a producer-led, or producer-as-auteur production system, and as such the producer has played a critical role in shaping the broader independent production landscape. In recent years, fundamental changes to distribution and consumption practices have had a major impact on the nature of screen production. Screen producers are increasingly migrating into emerging online, transmedia and cross-media production; generating both opportunities and challenges for traditional producers. However, the production cultures and motivations of producers operating in these emergent spaces remain poorly understood. This presentation will focus on the largely unremarked role of the producer in Australian screen scholarship. It will explore the ways in which the practice of screen producing is evolving and the migratory pathways of traditional producers moving into digital/new media production. The presentation’s primary findings are drawn from the 2011 Australian Screen Producer Survey; a national study of the activities of Australian screen producers conducted by the ARC Centre of Excellence for Creative Industries and Innovation (CCI), Queensland University of Technology, with support from the Centre for Screen Business /Australian Film Television and Radio School (AFTRS). From longitudinal analysis, the presentation will compare and contrast data from the 2009 and 2011 survey across film, television, corporate production and new media industry segments. In so doing the presentation will delineate the practices, attitudes, strategies, and aspirations of screen producers operating in a convergent digital media marketplace and suggest ways forward for a more industrially cognisant approach to screen history.

A longitudinal study of mental health in refugees from Burma : the impact of therapeutic interventions

Objective: The present study seeks to examine the impact of therapeutic interventions for people from refugee backgrounds within a naturalistic setting. Method: Sixty-two refugees from Burma were assessed soon after arriving in Australia. All participants received standard interventions provided by a resettlement organisation which included therapeutic interventions, assessment, social assistance, and referrals where appropriate. At the completion of service provision a follow-up assessment was conducted. Results: Over the course of the intervention, participants experienced a significant decrease in symptoms of post-traumatic stress disorder, anxiety, depression and somatisation. Pre-intervention symptoms predicted symptoms post-intervention for post-traumatic stress, anxiety, and somatisation. Post-migration living difficulties, the number of traumas experienced, and the number of contacts with the service agency were unrelated to all mental health outcomes. Conclusions: In the first Australian study of its kind, reductions in mental health symptoms post-intervention were significantly linked to pre-intervention symptomatology and the number of therapy sessions predicted post-intervention symptoms of post-traumatic stress. Future studies need to include larger samples and control groups to verify findings.

The impact of litigation risk on corporate prospective disclosure : a review of the empirical literature

We review the literature on the impact of litigation risk (a form of external governance) on corporate prospective disclosure decisions as reflected in management earnings forecasts. From this analysis we identify four key areas for future research. First, litigation risk warrants more attention from researchers; currently it tends to be treated as a secondary factor impacting MEF decisions. Second, it would be informative from a governance perspective for researchers to explore why litigation risk has a differential impact on MEF decisions across countries. Third, understanding the interaction between litigation risk and forecast/firm-specific characteristics is important from management, investor and regulatory perspectives but is currently under-explored Last, research on the litigation risk and MEF attributes link is piecemeal and incomplete, requiring more integrated and expanded analysis.

"Are there any right or wrong answers in teaching philosophy": ethics, epistemology, and philosophy in the classroom

This article assesses undergraduate teaching students’ assertion that there are no right and wrong answers in teaching philosophy. When asked questions about their experiences of philosophy in the classroom for primary children, their unanimous declaration that teaching philosophy has ‘no right and wrong answers’ is critically examined across the three sub-disciplinary areas to which they were generally referring, namely, pedagogy, ethics, and epistemology. From a pedagogical point of view, it is argued that some teaching approaches may indeed be more effective than others, and some pupils’ opinions less defensible, but pedagogically, in terms of managing the power relations in the classroom, it is counter-productive to continually insist on notions of truth and falsity at every point. From an ethical point of view, it is contended that anti-realist approaches to meta-ethics may represent a viable intellectual position, but from the point of view of normative ethics, notions of right and wrong still retain significant currency. From an epistemological point of view, it is argued using Karl Poppers’ work that while it may be difficult to determine what constitutes a right answer, determining a wrong one is far more straightforward. In conclusion, it is clear that prospective teachers engaging in philosophy in the classroom, and also future teachers in general, require a far more nuanced philosophical understanding of the notions of right and wrong and truth and falsity. In view of this situation, it we wish to promote the effective teaching of philosophical thinking to children, or produce educators who can understand the conceptual limits of the claims they make and their very real and often serious practical and social consequences, it is recommended that philosophy be reinstated to a fundamental, foundational place within the pre-service teaching curriculum.

Between formal and informal : the shakeout in China’s online video industry

While a rich body of literature in television and film studies and media policy studies has tended to focus on the media activities in the formal sector, we know much less about informal media activities, its influence on state policies, as well as the dynamics between the formal and the informal sectors. This article examines these issues with reference to a particularly revealing period following a large-scale government crackdown on peer-to-peer video sharing sites in China in 2008. By analyzing the aim and consequences of the state action, I point to the counter-productive effect in terms of cultural loss and the resurgence of offline piracy; and show the positive impact on forcing the informal into the formal sector, and pressuring the formal to innovate. Meanwhile, an increasing rapprochement between professional and user-created content leads to a new relationship between formal and informal sectors. This case demonstrates the importance of considering the dynamics between the two sectors. It also offers compelling evidence of the role of the informal sector in engendering state action, which in turn impacted on the co-evolution of the formal and the informal sectors.

Making a case for social impact assessment in urban development : social impacts and legal disputes in Queensland, Australia

Urban land use planning and policy decisions are often contested, with the multiple stakeholders (business, developers, residents, policymakers and the wider community) frequently holding opposing viewpoints about the issues and best solution. In recent years, however, the participatory process of social impact assessment (SIA) has received significant attention as a way to mitigate conflict, facilitating negotiation and conflict resolution. This paper examines how social impacts have informed development appeals in Australia, focussing on ten cases from the Queensland Planning and Environment Court (QPEC). Half are appeals from community members (typically neighbours) wanting to oppose approvals and half from organisations appealing against City Councils’ decisions to deny their development applications. While legal challenges do not necessarily reflect attitudes and practices, they provide a means to begin to assess how social impacts (although not often explicitly defined as such) inform development related disputes. Based on the nature and outcomes of 10 QPEC cases, we argue that many legal cases could have been avoided if SIA had been undertaken appropriately. First, the issues in each case are clearly social, incorporating impacts on amenity, the character of an area, the needs of different social groups, perceptions of risk and a range of other social issues. Second, the outcomes and recommendations from each case, such as negotiating agreements, modifying plans and accommodating community concerns would have been equally served thorough SIA. Our argument is that engagement at an early stage, utilising SIA, could have likely achieved the same result in a less adversarial and much less expensive and time-consuming environment than a legal case.

Impact fees and new housing cost: A comparative analysis of the empirical models

Developers and policy makers are consistently at odds over the debate as to whether impact fees increase house prices. This debate continues despite the extensive body of theoretical and empirical international literature that discusses the passing on to home buyers of impact fees, and the corresponding increase to housing prices. In attempting to quantify this impact, over a dozen empirical studies have been carried out in the US and Canada since the 1980’s. However the methodologies used vary greatly, as do the results. Despite similar infrastructure funding policies in numerous developed countries, no such empirical works exist outside of the US/Canada. The purpose of this research is to analyse the existing econometric models in order to identify, compare and contrast the theoretical bases, methodologies, key assumptions and findings of each. This research will assist in identifying if further model development is required and/or whether any of these models have external validity and are readily transferable outside of the US. The findings conclude that there is very little explicit rationale behind the various model selections and that significant model deficiencies appear still to exist.

The impact of anxiety on processing efficiency : implications for the attentional control theory

The Attentional Control Theory (ACT) proposes that high-anxious individuals maintain performance effectiveness (accuracy) at the expense of processing efficiency (response time), in particular, the two central executive functions of inhibition and shifting. In contrast, research has generally failed to consider the third executive function which relates to the function of updating. In the current study, seventy-five participants completed the Parametric Go/No-Go and n-back tasks, as well as the State-Trait Anxiety Inventory in order to explore the effects of anxiety on attention. Results indicated that anxiety lead to decay in processing efficiency, but not in performance effectiveness, across all three Central Executive functions (inhibition, set-shifting and updating). Interestingly, participants with high levels of trait anxiety also exhibited impaired performance effectiveness on the n-back task designed to measure the updating function. Findings are discussed in relation to developing a new model of ACT that also includes the role of preattentive processes and dual-task coordination when exploring the effects of anxiety on task performance.

The impact of chronic childhood illness on family stress : a comparison between autism and cystic fibrosis

Compared the different patterns of stress reported by mothers of children (aged 5–12 yrs) with either a chronic physical illness (cystic fibrosis) or a chronic psychological disorder (autism), and children without a physical or psychological disorder. 24 mothers from each of these 3 groups completed a short form of the Questionnaire on Resources and Stress. Each clinical group exhibited different patterns of stressful response consistent with the nature of the disorder and the requirements of care imposed on the families. Autism contributed significantly more to family stress than did cystic fibrosis. The number of children in the family was not a significant variable. Implications for the development of family intervention programs are discussed

Intercultural competence in engineering education : who are we teaching?

BACKGROUND There is little doubt that our engineering graduates’ ability to identify cultural differences and their potential to impact on engineering projects, and to work effectively with these differences is of key importance in the modern engineering practice. Within engineering degree programs themselves there is also a significant need to recognise the impact of changing student and staff profiles on what happens in the classroom. The research described in this paper forms part of a larger project exploring issues of intercultural competence in engineering. PURPOSE This paper presents an observational and survey study of undergraduate and postgraduate engineering students from four institutions working in groups on tasks with a purely technical focus, or with a cultural and humanitarian element. The study sought to explore how students rate their own intercultural competence and team process and whether any differences exist depending on the nature of the task they are working on. We also investigated whether any differences were evident between groups of first year, second year and postgraduate students. DESIGN/METHOD The study used the miniCQS instrument (Ang & Van Dyne, 2008) and a Bales Interaction Process Analysis based scale (Bales, 1950; Carney, 1976) to collect students self ratings of group process, task management, and cultural experience and behaviour. The Bales IPA was also used for coding video observations of students working in groups. Survey data were used to form descriptive variables to compare outcomes across the different tasks and contexts. Observations analysed in Nvivo were used to provide commentary and additional detail on the quantitative data. RESULTS The results of the survey indicated consistent mean scores on each survey item for each group of students, despite vastly different tasks, student backgrounds and educational contexts. Some small, statistically significant mean differences existed, offering some basic insights into how task and student group composition could affect self ratings. Overall though, the results suggest minimal shift in how students view group function and their intercultural experience, irrespective of differing educational experience. CONCLUSIONS The survey results, contrasted with group observations, indicate that either students are not translating their experience (in the group tasks) into critical self assessment of their cultural competence and teamwork, or that they become more critical of team performance and cultural competence as their competence in these areas grows, so their ratings remain consistent. Both outcomes indicate that students need more intensive guidance to build their critical self and peer assessment skills in these areas irrespective of their year level of study.

Teacher aides and their pedagogical contributions in the underachieving Indigenous mathematics classroom

This study examines the pedagogical contributions made by teacher aides in underperforming Indigenous mathematics secondary classrooms. Three teaching teams, each consisting of a teacher and their teacher aide, responded to semi-structured interviews. Their mathematics classrooms were observed for details of pedagogical contributions to the mathematics lessons. It was found that the pedagogical contributions of the teacher aides varied from co-teaching contributions, to the provision of menial support and behaviour management. The techniques used by the teacher aides to provide student feedback, to support behaviour management and to undertake questioning vary greatly, and this variance is also evident in the classroom atmosphere. Teacher aides are providing pedagogical contributions, and are engaged in instructional interactions, and are in a sense “teaching”.

The impact of penalty increases on speeding behaviour in Queensland and a characterisation of speeding offenders

This project examined the effects of speeding penalty changes that occurred in Queensland in 2003 on the behaviour of speeding offenders. These penalty changes included increasing the number of offence categories, and in turn narrowing the range of speeds associated with the offence categories; increasing the monetary fines for all offences, with the largest increases observed for high-range offences; and introducing automatic licence suspension and an eight demerit point penalty for the highest offence category. To explore the impact of the penalty changes, offence data collected for two cohorts of motorists in Queensland who were caught speeding prior to and subsequent to the penalty changes (N = 84,456) were compared. The first cohort consisted of individuals (operators of all vehicles including motorcycles) who committed a speeding offence in May 2001 (two years prior to the speeding penalty change); and individuals who committed a speeding offence in May 2003 (one month after the introduction of the penalty change). Four measures of recidivism were devised and used to assess the effects of the new penalties with regard to deterring the speeding behaviour of offenders. Additionally, the project investigated the relationship between speeding offences, other risky driving behaviours, crash involvement, and criminal behaviour.