An exploratory study of staff nurses' knowledge of delirium in the medical ICU: An Asian perspective

Aim The aim of this study was to establish intensive care unit nurses’ knowledge of delirium within an acute tertiary hospital within South East Asia. Background Delirium is a common, life threatening and often preventable cause of morbidity and mortality among older patients. Undetected and untreated delirium is a catalyst to increased mortality, morbidity, functional decline and results in increased requirement for nursing care, healthcare expense and hospital length of stay. However, despite effective assessment tools to identify delirium in the acute setting, there still remains an inability of ICU nurses’ to accurately identify delirium in the critically ill patient especially that of hypoactive delirium. Method A purposive sample of 53 staff nurses from a 13-bedded medical intensive care unit within an acute tertiary teaching hospital in South East Asia were asked to participate. A 40 item 5-point Likert scale questionnaire was employed to determine the participants’ knowledge of the signs and symptoms; the risk factors and negative outcomes of delirium. Results The overall positively answered mean score was 27 (67.3%) out of a possible 40 questions. Mean scores for knowledge of signs and symptoms, risk factors and negative outcomes were 9.52 (63.5%, n = 15), 11.43 (63.5%, n = 17) and 6.0 (75%, n = 8), respectively. Conclusion Whilst the results of this study are similar to others taken from a western perspective, it appeared that the ICU nurses in this study demonstrated limited knowledge of the signs and symptoms, risk factors and negative outcomes of delirium in the critically patient. The implications for practice of this are important given the outcomes of untreated delirium.

Intra-arterial waveform analysis: a study of senior nurse knowledge in a general intensive care unit

The aim of this small-scale study was to assess what knowledge senior nurses within a general intensive care unit (GICU) had in relation to intra-arterial blood pressure (IABP) waveform analysis. Its core objective was: To assess what knowledge was held by the senior nursing team with regard to arterial waveform interpretation, arterial waveform morphology and the technical aspects associated with arterial waveform monitoring.

Advancing nursing practice : redefining the theoretical and practical integration of knowledge

Aim The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. Background The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. Design The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. Method A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice. Conclusion There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. Relevance to clinical practice What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is pattern recognition, which became the focus of Benner’s work on expert practice. Therefore, if this is included into the knowing-how knowing-that framework, the knowing-how becomes the knowledge that contributes to advancing and advanced practice and the knowing-that becomes the governing action based on a deeper understanding of the problem or issue.

Advancing practice in critical care : a model of knowledge integration

Aim The aim of this paper was to discuss the potential development of a conceptual model of knowledge integration pertinent to critical care nursing practice. A review of the literature identified that reflective practice appeared to be at the forefront of professional development. Background It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individual’s practice, which then leads onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example, practice development initiatives can be seen as advancing practice for the masses, which ensures that practitioners are following the same level and practice of care. The question here is, are they developing individually? Relevance to clinical practice What this paper presents is that reflection may not be best suited to advancing practice if the individual practitioner does not have a sound knowledge base both theoretically and experientially. The knowledge integration model presented in this study uses multiple learning strategies that are focused in practice to develop practice, e.g. the use of work-based learning and clinical supervision. To demonstrate the models application, an exemplar of an issue from practice shows its relevance from a practical perspective. Conclusions In conclusion, further knowledge acquisition and its relationship with previously held theory and experience will enable individual practitioners to advance their own practice as well as being a resource for others.

What knowledge do ICU nurses have with regard to the effects of noise exposure in the Intensive Care Unit?

This small-scale study was undertaken to assess what knowledge nursing staff from a General Intensive Care Unit held with regard to noise exposure. To assess knowledge a self-administered multiple-choice questionnaire was used. Rigorous peer-review insured content validity. This study produced poor results in terms of the knowledge nurses held with regard to noise related issues in particular the psychophysiological effects and current legislation concerning its safe exposure. Non-parametric testing, using Kruskal–Wallis found no significant difference between nursing grades, however, descriptive analysis demonstrated that the staff nurse grade (D and E) performed better overall. Whilst the results of this study may seem self-evident in some respects, it is the problems of exposure to excessive noise levels for both patients and hospital personnel, which are clearly not understood. The effects noise exposure has on individuals for example decreased wound healing; sleep deprivation and cardiovascular stimulation must be of concern especially in terms of patient care but more so for nursing staff especially the effects noise levels can have on cognitive task performance.

New Knowledge for Advancing Practice in Pain Management

This chapter contains sections titled: Introduction Advancing practice in pain management Conclusions References

Knowledge transfer through dual degree programs : perspectives from Indonesian universities

The thesis provides an Indonesian perspective into the rationales and outcomes of cooperation between Indonesian and Australian universities. It demonstrates that Indonesian universities participating in this study have actively pursued their institutional agenda to bring benefits from the cooperation with the international partners and engaged in knowledge transfer with these partners to develop their capacity. It particularly investigates the knowledge transfer processes between Indonesian and Australian universities through dual degree program partnerships.

Informing healthy building design with biophilic urbanism design principles : a review and synthesis of current knowledge and research

Links between human health and wellbeing, and contact with nature are well understood in the fields of health and psychology, and more recently are gaining attention in the built environment industry. In 1984, E.O. Wilson coined the term ‘biophilia’ to describe the tendency for humans to have an innately emotional response to other living organisms. A growing number of researchers around the world are now exploring the impact of nature in urban environments (i.e. biophilic urbanism) on the human condition, including many indicators of human physical and mental health, recovery and performance. There is also an emergence of research on the potential for biophilic urbanism to address other challenges related to climate change mitigation and adaptation. This paper presents key findings from a review of key literature to date, discussing opportunities for biophilic urbanism to both improve occupant experience and performance, as well as addressing other sustainability objectives including climate change mitigation and adaptation. The paper presents an emerging framework for considering biophilic design opportunities and highlights implications for the built environment industry. This research draws on an Australian project considering biophilic urbanism in the response to climate change, within the Sustainable Built Environment National Research Centre. This includes findings from a literature review, a survey pilot study and two workshops undertaken in Perth and Brisbane with a variety of industry and government stakeholders.

Social media and tacit knowledge sharing : physicians' perspectives and experiences

Tacit knowledge sharing amongst physicians is known to have a significant impact on the quality of medical decisions. This thesis posits that social media can provide new opportunities for tacit knowledge sharing amongst physicians, and demonstrates this by presenting findings from a review of relevant literature and a qualitative survey conducted with physicians. Using thematic analysis, the study revealed five major themes and over twenty sub-themes as potential contributions of social media to tacit knowledge flow amongst physicians.

Why not the best schools? [The series]

"Expectations have been raised in Australia and comparable countries for an 'education revolution' that will secure success for all students in all settings. Such a revolution must ensure the alignment of educational outcomes, the skills required for a strong economy, and the needs of a harmonious society. Why not the Best Schools? offers a ten-point, ten-year plan for an education revolution that will result in the transformation of Australia's schools. Why not the Best Schools? goes beyond system characteristics to provide an in-depth account of how transformation occurs in schools. Fifty indicators are provided to help shape strategies for policy makers and practitioners in schools and school systems. Guidelines for leadership and governance ensure a future-focus for those who are determined to ensure that all students will succeed in the twentieth-first century. This book draws on a five-year study culminating in the International Project to Frame the Transformation of Schools conducted in Australia, China, England, Finland, the United States and Wales. The findings are consistent with the McKinsey & Company report on the world's best performing school systems and those arising from OECD's PISA."--publisher website

Working knowledge for collaborative water planning in Australia’s Wet Tropics region

Cooperation between multiple environmental decision-makers and activities is necessary to address the impacts of diffuse sources of agricultural pollution on the water quality entering Australia’s Great Barrier Reef (GBR). Water planning efforts requires available knowledge to inform this co-operative water program implementation and reform. This paper uses knowledge sharing, translation and feedback features of collaboration as a way to assess knowledge work practices during key phases of the water planning process. This enabled a systematic review of knowledge work practices in partnership with collaborative water planning groups established to inform water quality program investment decisions in the GBR’s Wet Tropics region. This research builds on the growing academic and policy interest in the conditions required to enable different types of knowledge to be successfully used for policy-making by focusing on when, how and why knowledge work to meet these conditions is required.

Cultural drivers of high performing knowledge-intensive service organisations

Organisational culture is considered an important influence on performance, particularly for service firms that rely on values-driven social controls to enhance human interactions (O’Reilly & Chatman, 1996). Using a qualitative approach, we show how the modified Organisational Culture Profile developed by Sarros, Gray, Densten, and Cooper (2005) to assess Australian organisations provides a framework for exploring the cultural drivers of high performing knowledge-intensive service firms in New Zealand. Our study provides rich insights into how six key cultural dimensions–competitiveness, innovation, performance orientation, emphasis on rewards, supportiveness and social responsibility–are translated into strategic human resource management practices.

Telling bodies, mapping knowledge : recontextualising the dancer’s corporeality using a modular choreographic model

Creative Development: The Body and Light. Within the current cultural climate, the independent choreographer struggles to pursue and establish their artistic career outside the infrastructure of mainstream dance companies. The independent choreographer is challenged to articulate alternative choreographic models without the support of that infrastructure. My research examines that challenge by exploring my own independent choreographic practice through a number of performance-based dance projects. This exploration will be underpinned by theoretical research to enable clarification of the tacit understandings of an embodied practice and the point of intersection between practice and theory so as to articulate alternative choreographic models. As a starting point for that enquiry, an example is provided of how questions that emerge from within the choreographic practice can be discussed in terms of research through an initial investigation exploring light in relation to the moving body and the implications of atmospheres.

The effectiveness of an intervention in reducing risk of dioxin exposure in Da Nang : changes in community knowledge, attitudes and prevention practices after 2.5 years

Introduction Environmental and biological samples taken around Da Nang Air Base have shown elevated levels of dioxin over many years [1-3]. A pre-intervention knowledge, attitudes and practices (KAP) survey (2009), a risk reduction program (2010) and a post intervention KAP survey (2011) were undertaken in four wards surrounding Danang Airbase. A follow-up evaluation was undertaken in 2013. Methods A KAP survey was implemented among 400 randomly selected food handlers. Eleven indepth interviews and four focus group discussions were also undertaken. Results The knowledge of respondents remained positive and/or improved at 2.5 years follow-up. There were no significant differences in attitudes toward preventing dioxin exposure across surveys; most respondents were positive in all three surveys. An increase in households (69.5%) undertaking measures to prevent exposure was observed, which was higher than in the pre-intervention survey (39.6%) and post- intervention survey (60.4%) (χ2 = 95.6; p < 0.001). The proportion of respondents practicing appropriate preventive measures was also significantly improved. Conclusions Despite most of the intervention program’s activities ceasing in 2010, the risk reduction program has resulted in positive outcomes over the longer-term, with many knowledge and attitude measures remaining stable or imporving. Some KAP indicators decreased, but these KAP indicators were still significantly higher than the pre-intervention levels.