The provision of patient personal hygiene in the intensive care unit : a descriptive exploratory study of bed-bathing practice

Background/objectives The provision of the patient bed-bath is a fundamental nursing care activity yet few quantitative data and no qualitative data are available on registered nurses’ (RNs) clinical practice in this domain in the intensive care unit (ICU). The aim of this study was to describe ICU RNs current practice with respect to the timing, frequency and duration of the patient bed-bath and the cleansing and emollient agents used. Methods The study utilised a two-phase sequential explanatory mixed method design. Phase one used a questionnaire to survey RNs and phase two employed semi-structured focus group (FG) interviews with RNs. Data was collected over 28 days across four Australian metropolitan ICUs. Ethical approval was granted from the relevant hospital and university human research ethics committees. RNs were asked to complete a questionnaire following each episode of care (i.e. bed-bath) and then to attend one of three FG interviews: RNs with less than 2 years ICU experience; RNs with 2–5 years ICU experience; and RNs with greater than 5 years ICU experience. Results During the 28-day study period the four ICUs had 77.25 beds open. In phase one a total of 539 questionnaires were returned, representing 30.5% of episodes of patient bed-baths (based on 1767 bed occupancy and one bed-bath per patient per day). In 349 bed-bath episodes 54.7% patients were mechanically ventilated. The bed-bath was given between 02.00 and 06.00 h in 161 episodes (30%), took 15–30 min to complete (n = 195, 36.2%) and was completed within the last 8 h in 304 episodes (56.8%). Cleansing agents used were predominantly pH balanced soap or liquid soap and water (n = 379, 71%) in comparison to chlorhexidine impregnated sponges/cloths (n = 86, 16.1%) or other agents such as pre-packaged washcloths (n = 65, 12.2%). In 347 episodes (64.4%) emollients were not applied after the bed-bath. In phase two 12 FGs were conducted (three FGs at each ICU) with a total of 42 RN participants. Thematic analysis of FG transcripts across the three levels of RN ICU experience highlighted a transition of patient hygiene practice philosophy from shades of grey – falling in line for inexperienced clinicians to experienced clinicians concrete beliefs about patient bed-bath needs. Conclusions This study identified variation in process and products used in patient hygiene practices in four ICUs. Further study to improve patient outcomes is required to determine the appropriate timing of patient hygiene activities and cleansing agents used to improve skin integrity.

The centrality of teachers’ judgement practice in assessment : a study of standards in moderation

There is a strong quest in several countries including Australia for greater national consistency in education and intensifying interest in standards for reporting. Given this, it is important to make explicit the intended and unintended consequences of assessment reform strategies and the pressures to pervert and conform. In a policy context that values standardisation, the great danger is that the technical, rationalist approaches that generalise and make superficial assessment practices, will emerge. In this article, the authors contend that the centrality and complexity of teacher judgement practice in such a policy context need to be understood. To this end, we discuss and analyse recorded talk in teacher moderation meetings showing the processes that teachers use as they work with stated standards to award grades (A to E). We show how they move to and fro between (1) supplied textual artefacts, including stated standards and samples of student responses, (2) tacit knowledge of different types, drawing into the moderation, and (3) social processes of dialogue and negotiation. While the stated standards play a part in judgement processes, in and of themselves they are shown to be insufficient to account for how the teachers ascribe value and award a grade to student work in moderation. At issue is the nature of judgement as cognitive and social practice in moderation and the legitimacy (or otherwise) of the mix of factors that shape how judgement occurs.

Deliberation and journalism

The first chapter in 'International Journalism and Democracy' re-examines current ideas about the role of journalism in promoting democracy, introducing the concept of "deliberative journalism". 'Deliberation and Journalism' lists the ways in which journalists can assist deliberation and politics in communities around the world. The chapter defines deliberation as a specific form of conversation that precedes and promotes decision-making and action by members of a community. The author recognises the difficulty of engaging in deliberation in communities that are divided by different interests, identities, backgrounds, resources and needs. She provides examples of strategies that journalists can use to encourage inclusive and productive deliberation in the face of community diversity. The chapter introduces examples of types of deliberative journalism that have emerged around the globe. These include strategies that have been sometimes been labeled as public journalism, civic journalism, peace journalism, development journalism, citizen journalism, the street press, community journalism, environmental journalism, and social entrepreneurism. The chapter also includes models of journalism that have not yet been given any particular name. Although the book identifies problems surrounding the theory and practice of these forms of journalism, the author notes that this is to be expected. Most models of deliberative journalism are relatively new, with none being more than a few decades old. The author concludes that resolution of these problems will only occur incrementally.

Anxiety and Aboriginal and Torres Strait Islander young people

This chapter outlines issues of excessive anxiety in Indigenous youth. It describes what an anxiety disorder is and its consequences and how Indigenous youth seem to be at risk for developing such disorders. Issues concerning the delivery of traditional prevention and intervention programs are discussed and possible interventions are provided.

Microblogging as a literacy practice for educational communities

Microblogging is an emergent adolescent and adult literacy practice that has become popularized through platforms such as Twitter, Plurk and Jaiku, in the rise of Web 2.0 – “the social web”. Yet the potentials of microblogging for literacy learning in educational contexts is currently underexplored in the research and literature. This article draws on new research with 150 adolescent and adult participants in school and university contexts, which was made possible through cross-disciplinary collaboration between specialists English and Information and Communication Technologies (ICT) educators. Strategies are provided for teachers to establish their own microblogging networks, with suggested activities to enhance the literacy learning of adolescents in educational contexts.

From Jindabyne to 'Jindabyne' : immigrant and indigenous specters

This paper reads Ray Lawrence's film Jindabyne (2006) in order to consider how "Australian" connotes as "immigrant" or "Indigenous" in contemporary Australia. Although the film is an adaptation of an American short story, it exploits an existing grammar of place in Australian cultural production in order to interrogate this very culture. If questions of race, gender, and class have haunted post-settlement Australia, Lawrence's film simultaneously stages these spectres and gestures towards the necessary failure of any attempt to exorcise them in a place where indigeneity is invisible. Thus, the location of Jindabyne, the town drowned in the name of progress, offers an exemplary visual metaphor for the failed project of identity formation in a place where forgetting is a survival tool.

Best practice for prevention and treatment of cardiovascular disease through an equity lens : a review

Background: Despite declining rates of cardiovascular disease (CVD) mortality in developed countries, lower socioeconomic groups continue to experience a greater burden of the disease. There are now many evidence-based treatments and prevention strategies for the management of CVD and it is essential that their impact on the more disadvantaged group is understood if socioeconomic inequalities in CVD are to be reduced. Aims: To determine whether key interventions for CVD prevention and treatment are effective among lower socioeconomic groups, to describe barriers to their effectiveness and the potential or actual impact of these interventions on the socioeconomic gradient in CVD. Methods: Interventions were selected from four stages of the CVD continuum. These included smoking reduction strategies, absolute risk assessment, cardiac rehabilitation, secondary prevention medications, and heart failure self-management programmes. Electronic searches were conducted using terms for each intervention combined with terms for socioeconomic status (SES). Results: Only limited evidence was found for the effectiveness of the selected interventions among lower SES groups and there was little exploration of socioeconomic-related barriers to their uptake. Some broad themes and key messages were identified. In the majority of findings examined, it was clear that the underlying material, social and environmental factors associated with disadvantage are a significant barrier to the effectiveness of interventions. Conclusion: Opportunities to reduce socioeconomic inequalities occur at all stages of the CVD continuum. Despite this, current treatment and prevention strategies may be contributing to the widening socioeconomic-CVD gradient. Further research into the impact of best-practice interventions for CVD upon lower SES groups is required.

Discrimination or Differential Involvement? A Review of the Research Exploring the Impact of Indigenous Status on Sentencing

Existing court data suggest that adult Indigenous offenders are more likely than non-Indigenous defendants to be sentenced to prison but once imprisoned generally receive shorter terms. Using findings from international and Australian multivariate statistical analyses, this paper reviews the three key hypotheses advanced as plausible explanations for these differences: 1) differential involvement, 2) negative discrimination, 3) positive discrimination. Overall, prior research shows strong support for the differential involvement thesis, some support for positive discrimination and little foundation for negative discrimination in the sentencing of Indigenous defendants. Where discrimination is found, we argue that this may be explained by the lack of a more complete set of control variables in researchers’ multivariate models.

Transforming educational practice : teachers' perceptions of embedding academic litaracy support within a B.Ed twinning program

An academic literacies approach frames students as active participants in their own learning as they develop their voice and identity. This paper describes teachers’ perceptions of developing and delivering an academic literacies program to TESOL pre-service teachers in a B.Ed twinning program. Data indicates that an academic literacies program is a dynamic process that is ever evolving in order to meet students’ needs. A cornerstone of the program was the continual and open communication between teachers to ensure that students’ needs were met. Additionally, a collaborative approach between twinning partners needs to occur in order for the benefits of the academic literacies program to continue for students.

My career chapter as a tool for reflective practice

This paper addresses reflective practice in research and practice and takes the issue of consciousness of social class in vocational psychology as a working example. It is argued that the discipline’s appreciation of social class can be advanced through application of the qualitative research method autoethnography. Excerpts from an autoethnographic study are used to explore the method’s potential. This reflexive research method is presented as a potential vehicle to improve vocational psychologists’ own class consciousness, and to concomitantly enhance their capacity to grasp social class within their own spheres of research and practice. It is recommended that autoethnography be used for research, training, and professional development for vocational psychologists.

Life on the edge : housing experiences in three remote Australian indigenous settlements

This analysis of housing experiences and aspirations in three remote Indigenous settlements in Australia (Mimili, Maningrida and Palm Island) reveals extreme liveability problems directly related to the scale and form of housing provision. Based upon field visits to each of the settlements and extensive interviews with residents and local housing and community officers, the paper analyses two aspects of living in such housing conditions at two spatial scales, the layout of the settlement and the design of individual houses. The failings at both scales are shown to be the fault of a dysfunctional housing system that is only recently been addressed.

Aesthetic tensions : evaluating outcomes for practice-led research and industry

This paper explores principles of contemporary aesthetics to suggest a basis for determining qualitative outcomes of artistic works in two contexts: the arts industry and the academy setting of practice-led research. Commonly articulated measures of quality—creativity and innovation—are questioned as mere rhetoric if not framed in specific ways in the two discrete settings. The paper also interrogates generally held assumptions that a longer time to develop work and greater periods of self-reflexivity will produce higher calibre artistic outcomes. The unease produced by apparent differences in qualitative outcomes between art works created in an industry setting and those created through practice-led research is analysed through three interconnected framing devices: intention, contextual parameters and criteria for evaluation, in conjunction with the relationships between the art work, the artist and the audience/viewer/listener. Common and differentiated criteria in the two contexts are explored, leading to the conclusion that innovation is more likely to be revealed in the end product in an industry context whereas in practice-led research it may be in the methodological processes of creating the work. While identifying and acknowledging that the two contexts encourage and produce distinctive qualitative artistic outcomes, both of value to the arts and the academy, the paper recommends ways in which closer formal liaison between industry artists and practice-led artists and supervisors might occur in order to ensure ongoing mutual influence and relevance.

Not yet the Internet election : online media, political commentary and the 2007 Australian federal election

This paper undertakes an overview of two developments in online media that coincided with the 'year-long campaign' that was the 2007 Australian Federal election. It discusses the relatively successful use of the Internet and social media in the 'Kevin07' Australian Labor Party campaign, and contrasts this to the Liberal-National Party's faltering use of You Tube for policy announcements. It also notes the struggle for authority in interpreting polling data between the mainstream media and various online commentators, and the 'July 12 incident' at The Australian, where it engaged in strong denunciation of alleged biases and prejudices among bloggers and on political Web sites. It concludes with consideration of some wider implication for political communication and the politics-media relationship, and whether we are seeing trends towards dispersal and diversification characterising the 'third age' of political communication.

Differences in Treatment and Management of Indigenous and Non-Indigenous Patients Presenting with Chest Pain: Results of the Heart Protection Partnership (HPP) Study

BACKGROUND: Indigenous patients with acute coronary syndromes represent a high-risk group. There are however few contemporary datasets addressing differences in the presentation and management of Indigenous and non-Indigenous patients with chest pain. METHODS: The Heart Protection Project, is a multicentre retrospective audit of consecutive medical records from patients presenting with chest pain. Patients were identified as Indigenous or non-Indigenous, and time to presentation and cardiac investigations as well as rates of cardiac investigations and procedures were compared between the two groups. RESULTS: Of the 2380 patients included, 199 (8.4%) identified as Indigenous, and 2174 (91.6%) as non-Indigenous. Indigenous patients were younger, had higher rates hyperlipidaemia, diabetes, smoking, known coronary artery disease and a lower rate of prior PCI; and were significantly less likely to have private health insurance, be admitted to an interventional facility or to have a cardiologist as primary physician. Following adjustment for difference in baseline characteristics, Indigenous patients had comparable rates of cardiac investigations and delay times to presentation and investigations. CONCLUSIONS: Although the Indigenous population was identified as a high-risk group, in this analysis of selected Australian hospitals there were no significant differences in treatment or management of Indigenous patients in comparison to non-Indigenous.