From policy to practice: the development of an integrated health promotion plan for children's services at Plenty Valley Community Health Inc.

Current changes in the funding of health promotion in community health in Victoria require community health agencies to integrate health promotion with service delivery. This provides both opportunities and challenges for community health staff. Members of the Children’s Service Team at Plenty Valley Community Health Inc. addressed these changes by developing an integrated health promotion plan. The approach used involved identifying client pathways and then integrating opportunities for health promotion interventions into these pathways. Staff perceptions of the process involved in developing the plan were examined. The use of client pathways to integrate health promotion into everyday practice proved a successful approach for members of the Children’s Services Team, and provides a useful model for health promotion planning in community health that helps staff to see the relevance of health promotion to their practice, and engages staff in the planning process. Members of the Children’s Services Team reported that the process involved in developing their integrated health promotion plan was a very worthwhile experience that allowed them a strong sense of ownership of the plan.

Evidence-based paediatric practice and its relation to the Cochrane Collaboration

Focuses on the relation between evidence-based pediatric practice and the Cochrane Collaboration on health care. Formation of the collaboration; Aim of Cochrane Collaboration; Reaction of pediatricians to the collaboration; Ways by which the collaboration ensures its relevance to pediatrics and child health.

Traversing the international rainbow of academia and architectural practice

In the context of contemporary tertiary education immersed as such in internationalisation strategies and internationalised curricula, the cultivation and promotion of international awareness in Australian graduates can be expected to lead to desirable lifelong attributes. Consideration of the need to be prepared for a globalised professional and cultural climate is integral to sustaining and growing the future and the fortunes of many. For the architectural community, the combined phenomena of globalisation and internationalisation strategies herald implications for the education and professional preparation of architects which traverse academia and architectural practice. This paper presents the case for exploring potential benefits of establishing closer links between academia and architecture practice, discusses the relevance of international student practice experience for the twenty first century and looks at its role within an intemationalised curriculum in preparing graduates for the future. Analysis of a survey of work experience as a component of Australian architecture courses is used to gauge the extent of current programs that seek to integrate the academic curriculum with practice experience, and the Deakin study (a work in progress) of architecture students in international practice contexts is presented as a vehicle for exploring the degree to which the combination of professional practice education and cultural experience may be beneficial to architecture students, academia and the profession more generally.

Tonic Sol-fa in contemporary choral music practice : a South African case study

The Tonic Sol-fa method of teaching choral singing was propagated throughout Britain during the nineteenth century with the dual objectives of enhancing Christian worship and achieving social reform. It was then imported to South Africa where it was introduced to indigenous people principally through Christian missionary activity and government schools. Although entirely of foreign origin, Tonic Sol-fa was so fully assimilated into African culture that it became effectively 'indigenised'. Due to its widespread use, it became the mainstay of community choral singing and may now be said to represent a significant exogenous aspect of present-day South African musical identity. However, there is little documentation regarding the type and extent of its use in contemporary choral music practice.

This paper will report on the use of Tonic Sol-fa in representative present-day choral music settings. Interview data collected from choir directors, trainers and teachers in Cape Town indicate that there is far from unanimous agreement on several aspects - in particular, the future of Tonic Sol-fa as a pedagogy and notational system. Improving educational opportunities for indigenous South Africans to undertake professional training in music are now threatening the traditional dominance of Tonic Sol-fa in indigenous culture. Nevertheless this research represents a useful case study of the continuing relevance of Tonic Sol-fa to an indigenous population who have 'made it their own' and developed a vibrant choral tradition which continues to both enrich and sustain their lives.

Australian sentencing : principles and practice

Australian Sentencing: Principles and Practice explains the rules, principles, policies and practices that underpin the manner in which people are punished for criminal behaviour in Australia. As well as dealing with sentencing law today, the book provides an extensive analysis of the wider policy, moral, and political consideration which shape sentencing law. It analyses and evaluates existing standards and practices, and suggests how sentencing law should be reformed so that it operates in a fairer, more efficient and effective manner.

Content: Part A: 1. The nature of sentencing and theories of punishment; 2. Plucking figures from the air: the instinctive synthesis; 3. The objectives that are attainable through sentencing; 4. High Court sentencing jurisprudence; Part B: 5. The principle of proportionality; 6. Aggravating factors; 7. Mitigating considerations; 8. The relevance of a guilty plea to sentence; 9. The relevance of prior criminality; 10. Aboriginality; Part C: 11. The nature of criminal sanctions; 12. Imprisonment; 13. Intermediate sanctions; 14. Discharges and bonds, fines and disqualifications; Part D: 15. The way forward ? strategic sentencing.

Changing places : testing the relevance of educational research and teacher education

Frequent reviews of teacher education in recent times seem to indicate that those charged with the responsibility for teacher education have little understanding of the contemporary needs of teachers. Just how does educational research inform teachers in their day-to-day practice and how is its relevance tested? As an educational researcher Professor Shirley Grundy challenges her own notions of 'relevance' by returning from academia to the school system in Western Australia. This experience expanded her understanding of how conceptual frameworks and the realities of schools complemented each other. She reflects on the agenda for change faced by education systems and the ensuing transformation of curriculum planning, pedagogy, assessment and reporting procedures in some schools while not in others.

Her reference to Habermas' work relating to 'system' and 'lifeworld' provided her with an explanation for the social conditions of schooling, while her exploration of discourse theory provides some understanding of the practices related to the exercise of power in school settings. Interchanges such as that experienced by Grundy are to the mutual benefit of both parties.

Exploring the possibilities of an expanded practice repertoire in child protection

Summary: This article discusses research that explored an alternative to proceduralized child protection practice informed by the risk paradigm, by expanding the repertoire available to practitioners through combining features of the risk paradigm with social constructionism. This approach incorporates three dimensions: theories of knowledge and power, related professional roles, and practice skills. In this article, we discuss and critically evaluate only the first dimension: theories of knowledge and power. Through dialogue facilitated by semi-structured questions, we explored practitioners' perspectives about the relevance and appropriateness of the alternative approach for practice.

Findings: The practitioners' participation and feedback offer insights into complex connections between `theory' and `practice' with the practitioner as a positioned subject and mediator of practical meanings of formal concepts.

Applications: 1) Recognition of each practitioner's interpretation of formal concepts and how they are applied in actual practice, even within shared organizational contexts. 2) The importance of dialogue to expand the range of possibilities that maintain openness to ongoing learning. 3) The value of theoretical pluralism that may offer greater opportunities for professional discretion, rather than single self-contained approaches that may constrain effective and ethical practice.

An evidence-based practice approach to improving nursing care of acute stroke in an Australian emergency department

Aims. The aim of this study was to improve the emergency nursing care of acute stroke by enhancing the use of evidence regarding prevention of early complications.
Background. Preventing complications in the first 24–48 hours decreases stroke-related mortality. Many patients spend considerable part of the first 24 hours following stroke in the Emergency Department therefore emergency nurses play a key role in patient outcomes following stroke.
Design. A pre-test/post-test design was used and the study intervention was a guideline for Emergency Department nursing management of acute stroke.
Methods. The following outcomes were measured before and after guideline implementation: triage category, waiting time, Emergency Department length of stay, time to specialist assessment, assessment and monitoring of vital signs, temperature and blood glucose and venous-thromboembolism and pressure injury risk assessment and interventions.
Results. There was significant improvement in triage decisions (21Æ4% increase in triage category 2, p = 0Æ009; 15Æ6% decrease in triage category 4, p = 0Æ048). Frequency of assessments of respiratory rate (p = 0Æ009), heart rate (p = 0Æ022), blood pressure (p = 0Æ032) and oxygen saturation (p = 0Æ001) increased. In terms of risk management, documentation of pressure area
interventions increased by 28Æ8% (p = 0Æ006), documentation of nil orally status increased by 13Æ8% (ns), swallow assessment prior to oral intake increased by 41Æ3% (p = 0Æ003), speech pathology assessment in Emergency Department increased by 6Æ1% (ns) and there was 93Æ5 minute decrease in time to speech pathology assessment for admitted patients (ns).
Relevance to clinical practice. An evidence-based guideline can improve emergency nursing care of acute stroke and optimise patient outcomes following stroke. As the continuum of stroke care begins in the Emergency Department, detailed recommendations for evidence-based emergency nursing care should be included in all multidisciplinary guidelines for the management of acute stroke.

Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting

Background. Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization. However, the research–practice gap remains a persistent issue for the nursing profession.

Aims and objectives. The aim of this study was to gain an understanding of perceived influences on nurses' utilization of research, and explore what differences or commonalities exist between the findings of this research and those of studies that have been conducted in various countries during the past 10 years.

Design. Nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. The instrument comprised a 29-item validated questionnaire, titled Barriers to Research Utilisation Scale (BARRIERS Scale), an eight-item scale of facilitators, provision for respondents to record additional barriers and/or facilitators and a series of demographic questions.

Method. The questionnaire was administered in 2001 to all nurses (n = 761) working at a major teaching hospital in Melbourne, Australia. A 45% response rate was achieved.

Results. Greatest barriers to research utilization reported included time constraints, lack of awareness of available research literature, insufficient authority to change practice, inadequate skills in critical appraisal and lack of support for implementation of research findings. Greatest facilitators to research utilization reported included availability of more time to review and implement research findings, availability of more relevant research and colleague support.

Conclusion. One of the most striking features of the findings of the present study is that perceptions of Australian nurses are remarkably consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade.

Relevance to clinical practice. If the use of research evidence in practice results in better outcomes for our patients, this behoves us, as a profession, to address issues surrounding support for implementation of research findings, authority to change practice, time constraints and ability to critically appraise research with conviction and a sense of urgency.

Cultural diversity, heritage and human rights : intersections in theory and practice

This theoretically innovative anthology investigates the problematic linkages between conserving cultural heritage, maintaining cultural diversity, defining and establishing cultural citizenship, and enforcing human rights.

It is the first publication to address the notions of cultural diversity, cultural heritage and human rights in one volume. Heritage provides the basis of humanity’s rich cultural diversity. While there is a considerable literature dealing separately with cultural diversity, cultural heritage and human rights, this book is distinctive and has contemporary relevance in focusing on the intersection between the three concepts. Cultural Diversity, Heritage and Human Rights establishes a fresh approach that will interest students and practitioners alike and on which future work in the heritage field might proceed.

Do high-risk medicines alerts influence practice?

Background: Medicine-related adverse events are prevalent, costly and mostly preventable. The High Risk Medicines Working Party (Victoria) developed and distributed three highrisk medicines alerts – wrong route of administration of oral medicines, subcutaneous insulin and unfractionated heparin – and accompanying audit tools in 2008 and 2009.
Aims: To determine the impact of the three high-risk medicines alerts on Victorian health services; to assess the clinical relevance and utility of the audit tools; to identify barriers to implementing recommendations; and to obtain feedback and suggestions for future alert topics.
Method: A cross-sectional survey was undertaken from 6 to 31 July 2009 using an online questionnaire. The questionnaire was distributed to 90 metropolitan, regional and rural public health services in Victoria and approximately 200 members of the Quality Use of Medicines Network (Victoria).
Results: Most of the 90 respondents were pharmacists (53%) and nurses (31%). 53 (59%) respondents reported making changes as a result of receiving the high-risk medicines alerts – 21 (40%) concerned the wrong route of administration, 12 (23%) subcutaneous insulin and 7 (13%) unfractionated heparin. Barriers to implementation included time constraints, inadequate staff and resources, excessive paperwork and competing priorities. A minority of respondents indicated some alerts were not relevant to small rural services. Suggestions for
improving the audit tools included making them less labour intensive, enabling electronic responses and ensuring their distribution is coordinated with other medicine-related tools.
Conclusion: High-risk medicines alerts and the accompanying audit tools facilitated change but there were some barriers to their implementation, such as time and resource constraints. Not all alerts and audit tools were relevant to all health services.

The delivery of a telephone coaching programme to people with type 2 diabetes by practice nurses in Victoria, Australia : a qualitative evaluation

Aim.  To evaluate telephone coaching undertaken by practice nurses in a randomised controlled trial of self-management support for people with type 2 diabetes.

Background.  Qualitative evaluation of the processes that take place in randomised controlled trials has the advantage of providing information on those variables that contribute to the success or failure of the randomised controlled trial. This additional information can be used to improve or modify chronic disease management programme designs.

Methods.  Grounded theory was used to analyse transcriptions of telephone coaching sessions between practice nurses and patient participants in the randomised controlled trial.

Findings.   Analysis of transcriptions found that patient participants had complex multiple medical conditions to manage, as well as maintaining their daily lives. Two approaches to working with this complexity by practice nurses emerged. We characterised one as ‘treat to target’ and the other as ‘personalised care’. While each approach shapes identities available to patients within the relationship with the practice nurse, the impact or effectiveness of these approaches on outcomes has yet to be reported.

Conclusions.  Telephone coaching takes place in complex social contexts as well as complex medical conditions. People with type 2 diabetes must manage their diabetes care and their care of other conditions within their social contexts. This means a constant negotiation of priorities.

Relevance to clinical practice.  Awareness of how health professional support for patients’ self-management becomes a relationship and element of the negotiated identity of patients is important in adapting clinical guideline-based protocols to achieving targets in the management of chronic illness.

Looking back to tomorrow : research, teaching and practice in IS

This position paper reflects on experiences in information systems practice, teaching and research, and considers the relevance of the recent trend to design thinking. It argues for the importance of maintaining an eclectic approach to the content, methods and hoped for outcomes of information systems education.

The science and practice of lithium therapy

Introduction: Despite more that 60 years of clinical experience, the effective use of lithium for the treatment of mood disorder, in particular bipolarity, is in danger of becoming obsolete. In part, this is because of exaggerated fears surrounding lithium toxicity, acute and long-term tolerability and the encumbrance of life-long plasma monitoring. Recent research has once again positioned lithium centre stage and amplified the importance of understanding its science and how this translates to clinical practice.

Objective: The aim of this paper is to provide a sound knowledge base as regards the science and practice of lithium therapy.

Method: A comprehensive literature search using electronic databases was conducted along with a detailed review of articles known to the authors pertaining to the use of lithium. Studies were limited to English publications and those dealing with the management of psychiatric disorders in humans. The literature was synthesized and organized according to relevance to clinical practice and understanding.

Results: Lithium has simple pharmacokinetics that require regular dosing and monitoring. Its mechanisms of action are complex and its effects are multi-faceted, extending beyond mood stability to neuroprotective and anti-suicidal properties. Its use in bipolar disorder is under-appreciated, particularly as it has the best evidence for prophylaxis, qualifying it perhaps as the only true mood stabilizer currently available. In practice, its risks and tolerability are exaggerated and can be readily minimized with knowledge of its clinical profile and judicious application.

Conclusion: Lithium is a safe and effective agent that should, whenever indicated, be used first-line for the treatment of bipolar disorder. A better understanding of its science alongside strategic management of its plasma levels will ensure both wider utility and improved outcomes.

Validation of the professional practice environment scale in Australian general practice

Purpose: To validate the Professional Practice Environment Scale (PPE) in Australian general practice. Methods: The PPE was modified slightly for appropriateness for the practice setting and administered to a sample of 342 Australian general practice nurses via an online survey tool. The factor structure of the 38-item PPE was examined using principal components analysis with Varimax rotation. Findings: An eight-factor solution accounted for 71.6% of the variance. Low factor loading (<0.3) or cross-component loadings were detected in eight items. A comparison of Cronbach's alpha values demonstrated little change in the deletion of eight items from four of the eight related components. Conclusions: Findings demonstrated that a 30-item version of the PPE was reliable and valid for use to assess the professional practice environment of nurses working in Australian general practice. Clinical Relevance: A tool to measure the professional practice environment in general practice is important as it will assist in monitoring the impact of the work environment on the recruitment, retention, and satisfaction of nurses in this setting.