Evaluation of contextual influences on the medication administration practice of paediatric nurses

Aim. This paper is a report of a study conducted to explore the impact of preidentified contextual themes (related to work environment and socialization) on nursing medication practice. Background. Medication administration is a complex aspect of paediatric nursing and an important component of day-to-day nursing practice. Many attempts are being made to improve patient safety, but many errors remain. Identifying and understanding factors that influence medication administration errors are of utmost importance. Method. A cross-sectional survey was conducted with a sample of 278 paediatric nurses from the emergency department, intensive care unit and medical and surgical wards of an Australian tertiary paediatric hospital in 2004. The response rate was 67%. Result. Contextual influences were important in determining how closely medication policy was followed. Completed questionnaires were returned by 185 nurses (67%). Younger nurses aged <34 years thought that their medication administration practice could be influenced by the person with whom they checked the drugs (P = 0·001), and that there were daily circumstances when it was acceptable not to adhere strictly to medication policy (P < 0·001), including choosing between following policy and acting in the best interests of the child (P = 0·002). Senior nurses agreed that senior staff dictate acceptable levels of medication policy adherence through role modelling (P = 0·01). Less experienced nurses reported greater confidence with computer literacy (P < 0·001). Conclusions. Organizations need to employ multidisciplinary education programmes to promote universal understanding of, and adherence to, medication policies. Skill mix should be closely monitored to ensure adequate support for new and junior staff.

Enhancing learning in dance technique through on-line-mediated reflective practice

‘Practice makes perfect’ expresses the common misconception that repetitive practice without appropriate feed-back will deliver improvement in tasks being practised. This paper explores the implementation of a student-driven feed-back mechanism and shows how functional and aesthetic understanding can be progressively enhanced through reflective practice. More efficient practice of clearly understood tasks will enhance dance training outcomes. We were looking for ways to improve teaching efficiency, effectiveness of the students’ practice in the studio and application of safe dance practices. We devised a web-based on-line format, ‘Performing Reflective Practice’, designed to augment and refine studio practice. Only perfect practice makes perfect!

Comprehension as social and intellectual practice : rebuilding curriculum in low socioeconomic and cultural minority schools

This article reframes the concept of comprehension as a social and intellectual practice. It reviews current approaches to reading instruction for linguistically and culturally diverse and low socioeconomic students, noting an emphasis on comprehension as autonomous skills. The Four Resources model (Freebody & Luke, 1990) is used to make the case for the integration of comprehension instruction with an emphasis on student cultural and community knowledge, and substantive intellectual and sociocultural content in elementary school curricula. Illustrations are drawn from research underway on the teaching of literacy in primary schools in low SES communities.

Mapping equity and diversity : from counting to culture change

This paper investigates the links between various approaches to managing equity and diversity and their effectiveness in changing the measures of inclusivity of women in organisations as a means of auditing and mapping managing diversity outcomes in Australia. The authors argue that managing diversity is more than changing systems and counting numbers it is also about managing the substantive culture change required in order to achieve inclusivity particularly intercultural inclusivity. Research in one sector of the education industry that investigated the competency skills required for culture change is offered as a model or guide for understanding and reflecting upon intercultural competency and its sequential development.

What are students' understandings of how digital tools contribute to learning in design disciplines?

Building Information Modelling (BIM) is evolving in the Construction Industry as a successor to CAD. CAD is mostly a technical tool that conforms to existing industry practices, however BIM has the capacity to revolutionise industry practice. Rather than producing representations of design intent, BIM produces an exact Virtual Prototype of any building that in an ideal situation is centrally stored and freely exchanged between the project team, facilitating collaboration and allowing experimentation in design. Exposing design students to this technology through their formal studies allows them to engage with cutting edge industry practices and to help shape the industry upon their graduation. Since this technology is relatively new to the construction industry, there are no accepted models for how to “teach” BIM effectively at university level. Developing learning models to enable students to make the most out of their learning with BIM presents significant challenges to those teaching in the field of design. To date there are also no studies of students experiences of using this technology. This research reports on the introduction of Building Information Modeling (BIM) software into a second year Bachelor of Design course. This software has the potential to change industry standards through its ability to revolutionise the work practices of those involved in large scale design projects. Students’ understandings and experiences of using the software in order to complete design projects as part of their assessment are reported here. In depth semi-structured interviews with 6 students revealed that students had views that ranged from novice to sophisticate about the software. They had variations in understanding of how the software could be used to complete course requirements, to assist with the design process and in the workplace. They had engaged in limited exploration of the collaborative potential of the software as a design tool. Their understanding of the significance of BIM for the workplace was also variable. The results indicate that students are beginning to develop an appreciation for how BIM could aid or constrain the work of designers, but that this appreciation is highly varied and likely to be dependent on the students’ previous experiences of working in a design studio environment. Their range of understandings of the significance of the technology is a reflection of their level of development as designers (they are “novice” designers). The results also indicate that there is a need for subjects in later years of the course that allow students to specialise in the area of digital design and to develop more sophisticated views of the role of technology in the design process. There is also a need to capitalise on the collaborative potential inherent in the software in order to realise its capability to streamline some aspects of the design process. As students become more sophisticated designers we should explore their understanding of the role of technology as a design tool in more depth in order to make recommendations for improvements to teaching and learning practice related to BIM and other digital design tools.

Quality issues for the National Bowel Cancer Screening Program (NBCSP)

Purpose: This two-part research project was undertaken as part of the planning process by Queensland Health (QH), Cancer Screening Services Unit (CSSU), Queensland Bowel Cancer Screening Program (QBCSP), in partnership with the National Bowel Cancer Screening Program (NBCSP), to prepare for the implementation of the NBCSP in public sector colonoscopy services in QLD in late 2006. There was no prior information available on the quality of colonoscopy services in Queensland (QLD) and no prior studies that assessed the quality of colonoscopy training in Australia. Furthermore, the NBCSP was introduced without extra funding for colonoscopy service improvement or provision for increases in colonoscopic capacity resulting from the introduction of the NBCSP. The main purpose of the research was to record baseline data on colonoscopy referral and practice in QLD and current training in colonoscopy Australia-wide. It was undertaken from a quality improvement perspective. Implementation of the NBCSP requires that all aspects of the screening pathway, in particular colonoscopy services for the assessment of positive Faecal Occult Blood Tests (FOBTs), will be effective, efficient, equitable and evidence-based. This study examined two important aspects of the continuous quality improvement framework for the NBCSP as they relate to colonoscopy services: (1) evidence-based practice, and (2) quality of colonoscopy training. The Principal Investigator was employed as Senior Project Officer (Training) in the QBCSP during the conduct of this research project. Recommendations from this research have been used to inform the development and implementation of quality improvement initiatives for provision of colonoscopy in the NBCSP, its QLD counterpart the QBCSP and colonoscopy services in QLD, in general. Methods – Part 1 Chart audit of evidence-based practice: The research was undertaken in two parts from 2005-2007. The first part of this research comprised a retrospective chart audit of 1484 colonoscopy records (some 13% of all colonoscopies conducted in public sector facilities in the year 2005) in three QLD colonoscopy services. Whilst some 70% of colonoscopies are currently conducted in the private sector, only public sector colonoscopy facilities provided colonoscopies under the NBCSP. The aim of this study was to compare colonoscopy referral and practice with explicit criteria derived from the National Health & Medical Research Council (NHMRC) (1999) Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer, and describe the nature of variance with the guidelines. Symptomatic presentations were the most common indication for colonoscopy (60.9%). These comprised per rectal bleeding (31.0%), change of bowel habit (22.1%), abdominal pain (19.6%), iron deficiency anaemia (16.2%), inflammatory bowel disease (8.9%) and other symptoms (11.4%). Surveillance and follow-up colonoscopies accounted for approximately one-third of the remaining colonoscopy workload across sites. Gastroenterologists (GEs) performed relatively more colonoscopies per annum (59.9%) compared to general surgeons (GS) (24.1%), colorectal surgeons (CRS) (9.4%) and general physicians (GPs) (6.5%). Guideline compliance varied with the designation of the colonoscopist. Compliance was lower for CRS (62.9%) compared to GPs (76.0%), GEs (75.0%), GSs (70.9%, p<0.05). Compliance with guideline recommendations for colonoscopic surveillance for family history of colorectal cancer (23.9%), polyps (37.0%) and a past history of bowel cancer (42.7%), was by comparison significantly lower than for symptomatic presentations (94.4%), (p<0.001). Variation with guideline recommendations occurred more frequently for polyp surveillance (earlier than guidelines recommend, 47.9%) and follow-up for past history of bowel cancer (later than recommended, 61.7%, p<0.001). Bowel cancer cases detected at colonoscopy comprised 3.6% of all audited colonoscopies. Incomplete colonoscopies occurred in 4.3% of audited colonoscopies and were more common among women (76.6%). For all colonoscopies audited, the rate of incomplete colonoscopies for GEs was 1.6% (CI 0.9-2.6), GPs 2.0% (CI 0.6-7.2), GS 7.0% (CI 4.8-10.1) and CRS 16.4% (CI 11.2-23.5). 18.6% (n=55) of patients with a documented family history of bowel cancer had colonoscopy performed against guidelines recommendations (for general (category 1) population risk, for reasons of patient request or family history of polyps, rather than for high risk status for colorectal cancer). In general, family history was inadequately documented and subsequently applied to colonoscopy referral and practice. Methods - Part 2 Surveys of quality of colonoscopy training: The second part of the research consisted of Australia-wide anonymous, self-completed surveys of colonoscopy trainers and their trainees to ascertain their opinions on the current apprenticeship model of colonoscopy in Australia and to identify any training needs. Overall, 127 surveys were received from colonoscopy trainers (estimated response rate 30.2%). Approximately 50% of trainers agreed and 27% disagreed that current numbers of training places were adequate to maintain a skilled colonoscopy workforce in preparation for the NBCSP. Approximately 70% of trainers also supported UK-style colonoscopy training within dedicated accredited training centres using a variety of training approaches including simulation. A collaborative approach with the private sector was seen as beneficial by 65% of trainers. Non-gastroenterologists (non-GEs) were more likely than GEs to be of the opinion that simulators are beneficial for colonoscopy training (χ2-test = 5.55, P = 0.026). Approximately 60% of trainers considered that the current requirements for recognition of training in colonoscopy could be insufficient for trainees to gain competence and 80% of those indicated that ≥ 200 colonoscopies were needed. GEs (73.4%) were more likely than non-GEs (36.2%) to be of the opinion that the Conjoint Committee standard is insufficient to gain competence in colonoscopy (χ2-test = 16.97, P = 0.0001). The majority of trainers did not support training either nurses (73%) or GPs in colonoscopy (71%). Only 81 (estimated response rate 17.9%) surveys were received from GS trainees (72.1%), GE trainees (26.3%) and GP trainees (1.2%). The majority were males (75.9%), with a median age 32 years and who had trained in New South Wales (41.0%) or Victoria (30%). Overall, two-thirds (60.8%) of trainees indicated that they deemed the Conjoint Committee standard sufficient to gain competency in colonoscopy. Between specialties, 75.4% of GS trainees indicated that the Conjoint Committee standard for recognition of colonoscopy was sufficient to gain competence in colonoscopy compared to only 38.5% of GE trainees. Measures of competency assessed and recorded by trainees in logbooks centred mainly on caecal intubation (94.7-100%), complications (78.9-100%) and withdrawal time (51-76.2%). Trainees described limited access to colonoscopy training lists due to the time inefficiency of the apprenticeship model and perceived monopolisation of these by GEs and their trainees. Improvements to the current training model suggested by trainees included: more use of simulation, training tools, a United Kingdom (UK)-style training course, concentration on quality indicators, increased access to training lists, accreditation of trainers and interdisciplinary colonoscopy training. Implications for the NBCSP/QBCSP: The introduction of the NBCSP/QBCSP necessitates higher quality colonoscopy services if it is to achieve its ultimate goal of decreasing the incidence of morbidity and mortality associated with bowel cancer in Australia. This will be achieved under a new paradigm for colonoscopy training and implementation of evidence-based practice across the screening pathway and specifically targeting areas highlighted in this thesis. Recommendations for improvement of NBCSP/QBCSP effectiveness and efficiency include the following: 1. Implementation of NBCSP and QBCSP health promotion activities that target men, in particular, to increase FOBT screening uptake. 2. Improved colonoscopy training for trainees and refresher courses or retraining for existing proceduralists to improve completion rates (especially for female NBCSP/QBCSP participants), and polyp and adenoma detection and removal, including newer techniques to detect flat and depressed lesions. 3. Introduction of colonoscopy training initiatives for trainees that are aligned with NBCSP/QBCSP colonoscopy quality indicators, including measurement of training outcomes using objective quality indicators such as caecal intubation, withdrawal time, and adenoma detection rate. 4. Introduction of standardised, interdisciplinary colonoscopy training to reduce apparent differences between specialties with regard to compliance with guideline recommendations, completion rates, and quality of polypectomy. 5. Improved quality of colonoscopy training by adoption of a UK-style training program with centres of excellence, incorporating newer, more objective assessment methods, use of a variety of training tools such as simulation and rotations of trainees between metropolitan, rural, and public and private sector training facilities. 6. Incorporation of NHMRC guidelines into colonoscopy information systems to improve documentation, provide guideline recommendations at the point of care, use of gastroenterology nurse coordinators to facilitate compliance with guidelines and provision of guideline-based colonoscopy referral letters for GPs. 7. Provision of information and education about the NBCSP/QBCSP, bowel cancer risk factors, including family history and polyp surveillance guidelines, for participants, GPs and proceduralists. 8. Improved referral of NBCSP/QBCSP participants found to have a high-risk family history of bowel cancer to appropriate genetics services.

Practice-led research and the innovation agenda : beyond the postgraduate research degree in the arts, design and media

The rise of the ‘practice-led’ research approach has given us a new way of understanding what creative practice in art, design and media can do in the academy and the world— it can materialise new ideas and forms into being as a form of experimental research. Yet, to date, attention around the world, and especially in Australia, has been chiefly directed at the postgraduate research degrees, most notably the PhD or doctoral equivalents. Recent mapping projects and surveys of practice-led research in Australia reveal much about the institutional conditions of higher degree researchers, supervisors, examiners and research training (Baker et al 2009; Evans et al 2003; Dally et al 2004; Paltridge et al 2009; Phillips et al 2009). Given this focus, we might well ask: is the practice-led approach destined to be a part of the higher degree ghetto only, or does it have an afterlife? What is the place of ‘practice-led’ beyond the postgraduate degree? After all postgraduate researchers do not remain postgraduates forever, and perhaps the practice-led approach to research may have benefits in wider university, professional and communal contexts.

Preparation of future weather data to study the impact of climate change on buildings

The dynamic interaction between building systems and external climate is extremely complex, involving a large number of difficult-to-predict variables. In order to study the impact of climate change on the built environment, the use of building simulation techniques together with forecast weather data are often necessary. Since most of building simulation programs require hourly meteorological input data for their thermal comfort and energy evaluation, the provision of suitable weather data becomes critical. In this paper, the methods used to prepare future weather data for the study of the impact of climate change are reviewed. The advantages and disadvantages of each method are discussed. The inherent relationship between these methods is also illustrated. Based on these discussions and the analysis of Australian historic climatic data, an effective framework and procedure to generate future hourly weather data is presented. It is shown that this method is not only able to deal with different levels of available information regarding the climate change, but also can retain the key characters of a “typical” year weather data for a desired period.

ePortfolio use by university students in Australia: Informing excellence in policy and practice

In mid 2007, the Australian Learning and Teaching Council (ALTC), formerly the Carrick Institute for Learning and Teaching in Higher Education, commissioned an intensive research project to examine the use of ePortfolios by university students in Australia. The project was awarded to a consortium of four universities: Queensland University of Technology as lead institution, The University of Melbourne, University of New England and University of Wollongong.---------- The overarching aim of the research project, which was given the working title of the Australian ePortfolio Project, was to examine the current levels of ePortfolio practice in Australian higher education. The principal project goals sought to provide an overview and analysis of the national and international ePortfolio contexts, document the types of ePortfolios used in Australian higher education, examine the relationship with the National Diploma Supplement project funded by the Federal government, identify any significant issues relating to ePortfolio implementation, and offer guidance about future opportunities for ePortfolio development. The research findings revealed that there was a high level of interest in the use of ePortfolios in the context of higher education, particularly in terms of the potential to help students become reflective learners who are conscious of their personal and professional strengths and weaknesses, as well as to make their existing and developing skills more explicit. There were some good examples of early adoption in different institutions, although this tended to be distributed across the sector. The greatest use of ePortfolios was recorded in coursework programs, rather than in research programs, with implementation generally reflecting subject-specific or program-based activity, as opposed to faculty- or university-wide activity. Accordingly, responsibility for implementation frequently rested with the individual teaching unit, although an alternative centralised model of coordination by ICT services, careers and employment or teaching and learning support was beginning to emerge. The project report concludes with a series of recommendations to guide the process, drawing on the need for open dialogue and effective collaboration between the stakeholders across the range of contexts: government policy, international technical standards, academic policy, and learning and teaching research and practice.

ePortfolio use by university students in Australia : Developing a sustainable community of practice

This report documents Stage Two of the Australian ePortfolio Project (AeP2), to specifically explore the current scope of national and international ePortfolio communities of practice in order to identify the factors that have contributed to their success and sustainability. The study has built on Stage One of the Australian ePortfolio Project (Hallam, Harper, McCowan, Hauville, McAllister, & Creagh, 2008), which outlined the broad range of issues and challenges, as well as significant opportunities, that faced the higher education sector in terms of ePortfolio practice, to determine how the emergent community of ePortfolio researchers and practitioners in Australia might be advanced. ---------- The overarching aims of this project were to focus on building the Australian community of practice through an online forum and further symposium activities. Through the research activities the project sought to generate the following major outcomes: develop a forum within the ALTC Exchange to support an ePortfolio community of practice; develop strategies to encourage interest in and engagement with community of practice activities; develop and promote resources to support the diverse stakeholders in ePortfolio practice; collaborate in the establishment of a cross-sector ePortfolio community of practice; host a second Australian ePortfolio Symposium (AeP2) to disseminate the findings from the Australian ePortfolio Project, to explore innovative practice in ePortfolio use in higher education, to articulate policy developments, and to stimulate discussion on international ePortfolio issues; host an associated trade display as a forum for strengthening the higher education sector’s understanding of the features and functionality of ePortfolio platforms; develop resources to support an ePortfolio symposium model that may be adopted for future events. ----------- The project activities encompassed a survey of stakeholders, a program of semi-structured interviews with community managers and a series of case studies depicting successful ePortfolio communities. The survey of ePortfolio practitioners sought to determine the potential value of an ePortfolio CoP, the preferred focus for and the desired features of such a community, as well as the options for the technical and social architecture of an online forum. Through the semi-structured interviews it was possible to examine current examples of CoP activity, to identify the critical success factors and the challenges faced by individual ePortfolio CoPs, so that the attributes of good practice could be presented. The data collected in the interviews contributed to the development of 14 case studies, which have been beneficial in illustrating the diverse nature of CoPs in Australia and overseas.----------- The report presents a rich picture of national and international ePortfolio communities of practice, with an examination of the factors that have contributed to their success and sustainability.

Caregivers' beliefs about practice in infant child care programmes

Infant caregivers in centre-based child care were videotaped as they interacted with the children during routine and non-routine activities. During a subsequent interview, the video provided a stimulus for discussion and reflection on practices. Caregivers were also asked to write about their beliefs on good practice in caring for infants. Transcripts of the interviews and the written statements were then analysed for evidence of nave and informed beliefs about caregiving. Most caregivers held nave beliefs and only one caregiver had an informed understanding of professional practice with infants. The usefulness of the analytical framework used in this research is discussed as a means for understanding caregiving practices. It has important implications for approaches to initial professional education of early childhood teachers and for professional development programmes.

Enhancing transition : an enhanced model of clinical placement for final year nursing students

Specialised support for student nurses making the transition to graduate nurse can be crucial to successful and smooth adjustment, and can create a path to positive and stable career experiences. This paper describes an enhanced model of final year nursing student placements which was trialled in 2006 at the Queensland University of Technology. The model involved collaboration with two major urban health services and resources were developed to support effective transition experiences. Ninety-two students, including 29 trial participants and 63 non-trial participants were assessed on preparedness for professional practice, before and after the trial semester. Results indicated an increase in preparedness across the entire sample, but students participating in the trial did not differ significantly in overall preparedness change from those who did not participate. Higher baseline preparedness in the trial group highlighted the possibility that proactive students who choose enrichment experiences tend to be likelier to gain benefit from such options than those who do not. Qualitative findings from focus groups conducted with 12 transition group students highlighted that one of the main beneficial aspects of the experience for students was the sense of belonging to a team that understood their learning needs and could work constructively with them.

Mechanisms of change in negative thinking and urinary monoamines in depressed patients during acute treatment with group cognitive behavior therapy and antidepressant medication

This naturalistic study investigated the mechanisms of change in measures of negative thinking and in 24-h urinary metabolites of noradrenaline (norepinephrine), dopamine and serotonin in a sample of 43 depressed hospital patients attending an eight-session group cognitive behavior therapy program. Most participants (91%) were taking antidepressant medication throughout the therapy period according to their treating Psychiatrists' prescriptions. The sample was divided into outcome categories (19 Responders and 24 Non-responders) on the basis of a clinically reliable change index [Jacobson, N.S., & Truax, P., 1991. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.] applied to the Beck Depression Inventory scores at the end of the therapy. Results of repeated measures analysis of variance [ANOVA] analyses of variance indicated that all measures of negative thinking improved significantly during therapy, and significantly more so in the Responders as expected. The treatment had a significant impact on urinary adrenaline and metadrenaline excretion however, these changes occurred in both Responders and Non-responders. Acute treatment did not significantly influence the six other monoamine metabolites. In summary, changes in urinary monoamine levels during combined treatment for depression were not associated with self-reported changes in mood symptoms.