Patient safety ethics and human error management in ED contexts part I : development of the global patient safety movement

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end patient safety has become the focus of a world-wide endeavour aimed at reducing the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments. In this article (the first of a two-part discussion on the subject) an overview of the incidence and impact of preventable adverse events in ED contexts is explored. The development of a ‘culture of safety’ in other hazardous industries and the ‘lessons learned’ and applied to the health care industry are also briefly examined. In a second article (to be presented as Part II), some of the ethical tensions that have arisen in the context of implementing patient safety processes and their possible implications for ED contexts are explored.

Patient safety ethics and human error management in ED contexts Part II : Accountability and the challenge to change

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end, patient safety has become the focus of a world-wide endeavour – endorsed by the World Health Organisation – to reduce the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments, of which the Emergency Department is a prime example. In Part I of this article series, an overview of the incidence and impact of preventable adverse events in Emergency Department contexts and the development of the global patient safety movement was presented. In this second article brief attention is given to examining some of the ethical tensions that have arisen in response to the patient safety movement and their possible implications for Emergency Department contexts and staff.

Clinical risk management and patient safety education for nurses : a critique

Nurses have a pivotal role to play in clinical risk management (CRM) and promoting patient safety in health care domains. Accordingly, nurses need to be prepared educationally to manage clinical risk effectively when delivering patient care. Just what form the CRM and safety education of nurses should take, however, remains an open question. A recent search of the literature has revealed a surprising lack of evidence substantiating models of effective CRM and safety education for nurses. In this paper, a critical discussion is advanced on the question of CRM and safety education for nurses and the need for nurse education in this area to be reviewed and systematically researched as a strategic priority, nationally and internationally. It is a key contention of this paper that without ‘good’ safety education research it will not be possible to ensure that the educational programs that are being offered to nurses in this area are evidence-based and designed in a manner that will enable nurses to develop the capabilities they need to respond effectively to the multifaceted and complex demands that are inherent in their ethical and professional responsibilities to promote and protect patient safety and quality care in health care domains.

Supporting beginning rural teachers : lessons from successful schools

Across Australia and internationally, the vexed problem of staffing rural school remains a major issue affecting the educational outcomes of many rural students and their families. TERRAnova, (New Ground’ in Teacher Education for Rural and Regional Australia), is the name of a large Australian Research Council funded (2008-2010) project involving: a national study of pre-service preparation and rural incentive schemes offered by both University and State government agencies, a longitudinal study of beginning teachers who take up rural appointments and a study of communities where teacher retention is high. In 2008 calls for nominations for rural schools with high rates of retaining beginning teachers were sought (over three years), and twenty-four of nearly fifty nominated schools were selected as case studies. Each case study has involved researchers from the TERRAnova team travelling and staying as close to the community nominated as possible. Numerous teaching staff, parents and community members were invited to be interviewed and their recordings were transcribed. Five of these case studies have now been completed, and this paper examines common themes derived from the strategies that support beginning teachers in these rural communities. Key factors emerging to date from the data relate to particular models of rural school leadership, ongoing teacher learning and mentoring, and school support and innovative community practices.

Cultural diversity in the Australian classroom and the experience of Arab-Muslim students

Table of Contents : Preface Introduction 1. Building the Australia-India Relationship- Bruce Bennett 2. Plural Cultures, Monolithic Structures- Kapila Vatsyayan 3. The Homogenised Other: Cultural Diversity and Social Inequality- Alan Mayne 4. Deliberative Democracy and Modern Pluralism- Subrata Mukherjee 5. ‘A long and winding road’. From Cultural Homogeneity to a Multicultural Society: An Analysis of Inclusion and Exclusion in Australia- David Roberts 6. Limits of Multiculturalism in a Liberal Polity: Need for a Shared Identity-Sushila Ramaswamy 7. “Australia is a Multicultural Community –you’ll feel at home”:Cultural Diversity and the Promotion of Australia Internationally- Andrew Hassam 8. Accommodation of Cultural Diversity in India: Reflections on Past and Present- Abdulrahim P. Vijapur 9. Gandhian Ideas on Cultural Diversity and Unity in India- Sailaja Gullapalli 10. Multiculturalism: Australian and Indian Approach-Sonu Trivedi 11. Post Colonial Formation, Paradigm Consolidation and Economic Marginalization- S. Ram Vemuri 12. Dalits and Indigenous Australians: Affirmative Actions and Existing Realities- Swaraj Basu 13. Exploring a Critical Tradition in Communications Research: A Cultural Discourse- Amita Singh 14. Education and Empowerment: Dalits and the Demand for Modern Education in Colonial India- Shashi Bhushan Upadhyay 15. Recent Developments in Indian Migration to Australia (with Special Reference to Academics)- Graeme Hugo and Gouranga Lal Dasvarma 16. Cultural Diversity in the Australian Classroom and the Experience of Arab-Muslim Students- Sally Percival Wood 17. Working Australia Efficiency and Equity- Liz Hall 18. North-East India’s Cultural Diversity: Trends of Unrest and Marginalization- Sudhir Jacob George 19. Socio-economic Inequities of Tribal Communities in India- Priti Singh 20. Reinventing Australian Identity-D. Gopal 21. Identity and Rights of the Diaspora in the Post-colonial Era- R. Narayanan 22. Understanding Cultural Diversity: Reflections from the Americas- Satya R. Pattnayak Contributors Index

Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

How do detectives make love? : themes of the survival of the child: corruption in relation to innocence

The major component of the thesis is a manuscript of poetry titled How do detectives make love? which includes forty poems written over a period of two years. Many of these; poems have been published in literary journals and magazines both in Australia and internationally as well as being performed at various performance poetry venues. How do detectives make love? was accepted for publication by Penguin Books, Australia in 1994. Also included is a 12,000 word exegesis in support of the manuscript titled How do detectives make love? Themes of the survival of the child: corruption in relation to innocence. The exegesis explores various themes and motifs occurring throughout the work, including the motif of birds and dogs, and the themes of love and the police, guns and weaponry, the outback and parklands, the parents, the change from childhood to adolescence and adolescence to adulthood, and the survival of the child. The current vital social relevance of these themes and motifs is explored in the poems. The literary use of the themes is explored comparatively with the work of other Australian poets including Gig Ryan, Kenneth Slessor and Les Murray. The purpose of the exegesis is to give the reader insights into the poet's intellectual processes and literary concerns throughout the work itself.

Cross-cultural adaptation of a tobacco questionnaire for Punjabi, Cantonese, Urdu and Sylheti speakers: qualitative research for better clinical practice, cessation services and research.Â

Objective : To develop cross‐culturally valid and comparable questionnaires for use in clinical practice, tobacco cessation services and multiethnic surveys on tobacco use.
Methods : Key questions in Urdu, Cantonese, Punjabi and Sylheti on tobacco use were compiled from the best existing surveys. Additional items were translated by bilingual coworkers. In one‐to‐one and group consultations, lay members of the Pakistani, Chinese, Indian Sikh and Bangladeshi communities assessed the appropriateness of questions. Questionnaires were developed and field tested. Cross‐cultural comparability was judged in a discussion between the researchers and coworkers, and questionnaires were finalised. Questionnaires in Cantonese (written and verbal forms differ) and Sylheti (no script in contemporary use) were written as spoken to avoid spot translations by interviewers.
Results : The Chinese did not use bidis, hookahs or smokeless tobacco, so these topics were excluded for them. It was unacceptable for Punjabi Sikhs to use tobacco. For the Urdu speakers and Sylheti speakers there was no outright taboo, particularly for men, but it was not encouraged. Use of paan was common among women and men. Many changes to existing questions were necessary to enhance cultural and linguistic appropriateness—for example, using less formal language, or rephrasing to clarify meaning. Questions were modified to ensure comparability across languages, including English.
Conclusion : Using theoretically recommended approaches, a tobacco‐related questionnaire with face and content validity was constructed for Urdu, Punjabi, Cantonese and Sylheti speakers, paving the way for practitioners to collect more valid data to underpin services, for sounder research and ultimately better tobacco control. The methods and lessons are applicable internationally.

Transitional issues of induction into design education for international undergraduate students : a case study analysis of architecture

The overarching aim of this paper is to present and discuss a collaborative undertaking between the School of Architecture and Building and the Academic Skills Unit at Deakin University, Australia in a programme called The Integrated Support Programme for Architecture. It does this in the following ways. It provides a justification for the setting up of an integrated programme for international architecture students. It describes the programme that was set up and outlines the reasons for collaboration between an academic School and an Academic Skills support services unit to prepare students both nationally and internationally as graduates of architecture. It then reports on a study undertaken to evaluate the programme in terms of student response and perception. Following this, it highlights directions for effective and strategic transition of past and present learning for international students. Using a case study analysis, the thrust of this paper is to advance knowledge and understanding of the pertinent issues related to international students either commencing or articulating into the professional course of architecture. It is envisaged that in this discussion matters may be raised for a strategic and effective transition of generic and internationalised learning for international students.

Environmental learning in adolescents from a Mexican community involved in forestry

Education can generate knowledge and foster a change in attitude provided that people feel individually and collectively responsible for the state of the environment. San Juan Nuevo Parangaricutiro is an internationally recognised indigenous community located in western Mexico that manages its forest sustainably through a community-based forest enterprise. However, recent research has shown that both children and young people from the community show little interest in participating in forest activities or working in forest enterprise and have a poor standard of environmental knowledge. Our research project assessed the environmental learning process of 32 high-school pupils in three settings: at school at home and in a forest enterprise. The opinions of teachers and adults of teaching subjects which focus on communal forest management were collected using various methods (questionnaires, observation and interviews) and analysed. The results show that school and home alike are important places for learning. However, environmental issues were not much addressed in the schoolroom or in conversations between parents and children. Furthermore, no connection between the activities of the forest enterprise and the school curriculum was found.

Issues arising from the implementation of a comprehensive assessment approach in a large, multi-modal Bachelor of Commerce unit

Recent literature in higher education argues university assessment has been too narrow and hasn’t adequately reflected the quality, breadth and depth of students’ learning. Research shows students often prioritise and learn what they need to know for formal, graded assessment and disregard other academic content seen as less relevant to those requirements. The predominance of essays and examinations has therefore tended to constrain learning. The case for a more comprehensive approach has been clearly articulated. So what happens when staff take up the unique challenge of designing fair and uniform assessment for a large, core, multi-modal, multi-campus unit offered nationally and internationally?

When developing an undergraduate Bachelor of Commerce unit at Deakin University, staff considered the most appropriate ways to assess a range of conceptual understandings and communication skills. This resulted in the mapping and adoption of a comprehensive approach incorporating teacher, peer, and self-assessment aspects, individual and group work, oral and written presentations, and the use of portfolios and journals. Particular practices were adopted to control workloads, ensure fairness in marking, and overcome some problems generally associated with group work. When implementing the approach, practical issues arose that demanded adjustments. This paper details the approach taken, outlines research activities, and discusses the practical implications of issues that arose.

Evaluating user involvement in primary healthcare

Current health policies, both in the UK and internationally, call for a shift from secondary to primary healthcare, and for increased involvement of service users and communities in decisions about their own care and about the way in which health services are provided. This study investigated the way in which users were involved in two London-based primary healthcare projects. Two projects were selected from a broader sample. A case study approach was adopted and a range of methods used to identify the types of user involvement, users' views of the process and, in one case study, users' preferences for participation. Arnstein's conceptual framework for participation was used in the analysis. In this paper, the findings of the study are discussed in relation to Cohen's notions of breadth, depth and range of participation. The paper illustrates how these notions may provide a mechanism for providers and commissioners of health services to assess their strategies in relation to user or community involvement, and the degree of success they achieve in implementation.

Developing reflexive capability for successful joint ventures between Australian and Malaysian property and construction professionals

Increasingly Malaysian property and construction firms are seeking to work internationally. Firms enter international markets through various strategies and typically property and construction professionals rely on developing various forms of cooperative and collaborative arrangements. The common modes of entry include international alliances, project joint ventures, partnerships, company joint ventures and large consortiums; which arise as a response to clients seeking expressions of interests from the international community or the firms seeking to internationalise approaching clients and/or potential host country partners. Increasingly project teams on international mega projects are composed of multiple key partners from different countries coming together to achieve a higher level of strategic flexibility. Establishing and maintaining local connections and business networks are therefore critical to ensure the success of exporting firms. This paper reports the findings of a project which explores factors affecting the performance of Malaysian property and construction professionals working internationally through effective joint ventures. The project seeks to develop a performance measurement framework to examine the extent to which Malaysian firms are developing sustainable business models internationally which adapt and respond to changing conditions. A generic framework was initially developed prior to this study through a grounded theory approach merging theory from internationalisation, design management and market knowledge literature followed by a case study empirical investigation and then further literature review based upon the themes which emerged from the case study analysis. A reflexive capability model for firms in managing both economic and non-economic capital; including social, cultural and intellectual capital was developed. This project seeks to build upon the reflexive model by adapting it to the unique contexts related to the specific geographic localities of exporting Malaysian firms. Specifically, the project explores the extent to which the performance measurement framework can be used to map capabilities Malaysian construction firms have and Which they need to develop in relation to developing and maintaining international collaborative partnerships. The preliminary results of one case study Malaysian architectural firm are discussed.

Contextualising learning through the participatory construction of an environmental education programme

Strengthening links between school and community is critical for improving people's participation in environmental issues. However, Mexican education programmes are generally unrelated to rural students' life experience and are planned without considering either teachers' or students' opinions. This article describes the participatory construction of a preparatory school environmental education (EE) programme in Ixtlan de Juarez, a Mexican indigenous community internationally recognised for sustainable forest management. The qualitative research methods used are based on the action research methodology. Results from interviews conducted with the preparatory school's headmaster, the coordinator, and nine teachers provided the needed documentation of the school site for contextualising learning activities. Feedback during focus groups with six students, three teachers, five local communal authorities, and two researchers highlighted that all participants perceived the need for creating an educational programme focused on local forest management. The contents and activities of the programme were designed by the focus group's participants. The programme has been continuously taught by teachers and forest workers since 2005 and was officially integrated with the preparatory school science curriculum in 2006. This participative educational experience has thus transformed the mandatory school curriculum in Ixtlan.

Psychological interventions for the prevention and management of lifestyle-related chronic disease

The Australian Government's current health reform agenda provides a timely opportunity to highlight the contribution of health psychology interventions in the prevention and management of chronic diseases associated with lifestyle risk factors. The World Health Organisation (2009) has identified the main risk factors responsible for deaths internationally as high blood pressure (responsible for 13% of deaths), tobacco use (9%), high blood sugar (6%), physical inactivity (6%), overweight and obesity (5%), high cholesterol (5%), unsafe sex (4%) and alcohol use (4%). A number of these factors also increase the risk of major chronic diseases - cardiovascular disease, diabetes and cancers. There is now a substantial evidence base for the effectiveness of health improvement interventions based on psychological theory, research and practice and hence they deserve a high level of recognition within systems for funding health. This article presents a summary of a systematic review of the evidence for the effectiveness of health psychology interventions in the prevention and treatment of chronic diseases associated with lifestyle risk factors.