Searching for value : the influence of policy and reform on nurses’ sense of value in long-term aged care in Australia.

Contemporary literature on long-term aged care focuses heavily on issues associated with the recruitment and retention of nursing staff, such as job satisfaction and attitudes towards caring for older people. This paper aims to highlight one aspect of a larger study of registered nurses' experiences in long-term aged care in Australia and the influence that government policy and reform has in shaping that experience. This insight into aspects of nurses' everyday experience also contributes to a broader understanding of job satisfaction in long-term care. Findings from this study suggest that registered nurses experience tension in their search for value in their practice, which incorporates professional, political and social mediators of value and worth. These issues are discussed in relation to the impact of policy and reform on nurses' sense of value in long-term aged care and highlight the need for sensitive policy initiatives that support issues of value in nursing practice.

A simplified approach for calculating the moments of action for linear reaction-diffusion equations

The mean action time is the mean of a probability density function that can be interpreted as a critical time, which is a finite estimate of the time taken for the transient solution of a reaction-diffusion equation to effectively reach steady state. For high-variance distributions, the mean action time under-approximates the critical time since it neglects to account for the spread about the mean. We can improve our estimate of the critical time by calculating the higher moments of the probability density function, called the moments of action, which provide additional information regarding the spread about the mean. Existing methods for calculating the nth moment of action require the solution of n nonhomogeneous boundary value problems which can be difficult and tedious to solve exactly. Here we present a simplified approach using Laplace transforms which allows us to calculate the nth moment of action without solving this family of boundary value problems and also without solving for the transient solution of the underlying reaction-diffusion problem. We demonstrate the generality of our method by calculating exact expressions for the moments of action for three problems from the biophysics literature. While the first problem we consider can be solved using existing methods, the second problem, which is readily solved using our approach, is intractable using previous techniques. The third problem illustrates how the Laplace transform approach can be used to study coupled linear reaction-diffusion equations.

End-of-life care in the critical care setting : nurses' practices and factors affecting these practices

Background: Critical care units are designed and resourced to save lives, yet the provision of end-of-life care is a significant component of nursing work in these settings. Limited research has investigated the actual practices of critical care nurses in the provision of end-of-life care, or the factors influencing these practices. To improve the care that patients at the end of life and their families receive, and to support nurses in the provision of this care, further research is needed. The purpose of this study was to identify critical care nurses' end-of-life care practices, the factors influencing the provision of end-of-life care and the factors associated with specific end-of-life care practices. Methods: A three-phase exploratory sequential mixed-methods design was utilised. Phase one used a qualitative approach involving interviews with a convenience sample of five intensive care nurses to identify their end-of-life care experiences and practices. In phase two, an online survey instrument was developed, based on a review of the literature and the findings of phase one. The survey instrument was reviewed by six content experts and pilot tested with a convenience sample of 28 critical care nurses (response rate 45%) enrolled in a postgraduate critical care nursing subject. The refined survey instrument was used in phase three of this study to conduct a national survey of critical care nurses. Descriptive analyses, exploratory factor analysis and univariate general linear modelling was undertaken on completed survey responses from 392 critical care nurses (response rate 25%). Results: Six end-of-life care practice areas were identified in this study: information sharing, environmental modification, emotional support, patient and family-centred decision making, symptom management and spiritual support. The items most frequently identified as always undertaken by critical care nurses in the provision of end-of-life care were from the information sharing and environmental modification practice areas. Items least frequently identified as always undertaken included items from the emotional support practice area. Eight factors influencing the provision of end-of-life care were identified: palliative values, patient and family preferences, knowledge, preparedness, organisational culture, resources, care planning, and emotional support for nurses. Strong agreement was noted with items reflecting values consistent with a palliative approach and inclusion of patient and family preferences. Variation was noted in agreement for items regarding opportunities for knowledge acquisition in the workplace and formal education, yet most respondents agreed that they felt adequately prepared. A context of nurse-led practice was identified, with variation in access to resources noted. Collegial support networks were identified as a source of emotional support for critical care nurses. Critical care nurses reporting values consistent with a palliative approach and/or those who scored higher on support for patient and family preferences were more likely to be engaged in end-of-life care practice areas identified in this study. Nurses who reported higher levels of preparedness and access to opportunities for knowledge acquisition were more likely to report engaging in interpersonal practices that supported patient and family centred decision making and emotional support of patients and their families. A negative relationship was identified between the explanatory variables of emotional support for nurses and death anxiety, and the patient and family centred decision making practice area. Contextual factors had a limited influence as explanatory variables of specific end-of-life care practice areas. Gender was identified as a significant explanatory variable in the emotional and spiritual support practice areas, with male gender associated with lower summated scores on these practice scales. Conclusions: Critical care nurses engage in practices to share control with and support inclusion of families experiencing death and dying. The most frequently identified end-of-life care practices were those that are easily implemented, practical strategies aimed at supporting the patient at the end of life and the patient's family. These practices arguably require less emotional engagement by the nurse. Critical care nurses' responses reflected values consistent with a palliative approach and a strong commitment to the inclusion of families in end-of-life care, and these factors were associated with engagement in all end-of-life care practice areas. Perceived preparedness or confidence with the provision of end-of-life care was associated with engagement in interpersonal caring practices. Critical care nurses autonomously engage in the provision of end-of-life care within the constraints of an environment designed for curative care and rely on their colleagues for emotional support. Critical care nurses must be adequately prepared and supported to provide comprehensive care in all areas of end-of-life care practice. The findings of this study raise important implications, and informed recommendations for practice, education and further research.

Analysis and prediction of the critical current density across [001]-tilt YBa2Cu3O7- grain boundaries of arbitrary misorientation angles

A qualitative analysis of the expected dilatation strain field in the vicinity of an array of grain-boundary (GB) dislocations is presented. The analysis provides a basis for the prediction of the critical current densities (jc) across low-angle YBa2Cu3O7- (YBCO) GBs as a function of their energy. The introduction of the GB energy allows the extension of the analysis to high-angle GBs using established models which predict the GB energy as a function of misorientation angle. The results are compared to published data for jc across [001]-tilt YBCO GBs for the full range of misorientations, showing a good fit. Since the GB energy is directly related to the GB structure, the analysis may allow a generalization of the scaling behavior of jc with the GB energy. © 1995 The American Physical Society.

The value of health and wellbeing : an empirical model of value creation in social marketing

Purpose The purpose of this paper is to investigate the role of multiple actors in the value creation process for a preventative health service, and observe the subsequent impact on key service outcomes of satisfaction and customer behaviour intentions to use a preventative health service again in the future. Design/methodology/approach An online self-completion survey of Australian women (n=797) was conducted to test the proposed framework in the context of a free, government-provided breastscreening service. Data were analysed using Structural Equation Modelling (SEM). Findings The findings indicate that functional and emotional value are created from organisational and customer resources. These findings indicate that health service providers and customers are jointly responsible for the successful creation of value, leading to desirable outcomes for all stakeholders. Practical implications The results highlight to health professionals the aspects of service that can be managed in order to create value with target audiences. The findings also indicate the importance of the resources provided by users in the creation of value, signifying the importance of customer education and management. Originality/value This study provides a significant contribution to social marketing through the provision of an empirically validated model of value creation in a preventative health service. The model demonstrates how the creation and provision of value can lead to the achievement of desirable social behaviours - a key aim of social marketing.

Critical factors for project efficiency in a defence environment

Defence projects are typically undertaken within a multi-project-management environment where a common agenda of project managers is to achieve higher project efficiency. This study adopted a multi-facet qualitative approach to investigate factors contributing to or impeding project efficiency in the Defence sector. Semi-structured interviews were undertaken to identify additional factors to those compiled from the literature survey. This was followed by a three-round Delphi study to examine the perceived critical factors of project efficiency. The results showed that project efficiency in the Defence sector went beyond its traditional internally focused scope to one that is externally focused. As a result, efforts are needed on not only those factors related to individual projects but also those factors related to project inter-dependencies and external customers. The management of these factors will help to enhance the efficiency of a project within the Defence sector.

A new method for quantifying the contribution of different critical agents on railway bridge deterioration

Railway Bridges deteriorate over time due to different critical factors including, flood, wind, earthquake, collision, and environment factors, such as corrosion, wear, termite attack, etc. In current practice, the contributions of the critical factors, towards the deterioration of railway bridges, which show their criticalities, are not appropriately taken into account. In this paper, a new method for quantifying the criticality of these factors will be introduced. The available knowledge as well as risk analyses conducted in different Australian standards and developed for bridge-design will be adopted. The analytic hierarchy process (AHP) is utilized for prioritising the factors. The method is used for synthetic rating of railway bridges developed by the authors of this paper. Enhancing the reliability of predicting the vulnerability of railway bridges to the critical factors, will be the significant achievement of this research.

Disengaged and disruptive : behaviour intervention for boys from year four to year seven

Disengaged and disruptive students have been an ongoing concern for teachers for many years. Teaching is complex—complex students with complex lives and complex behaviours. How best to help these students is an ever-present question without a simple answer. Solutions need to be found. Under a positive behaviour support framework when serious, disruptive behaviour requires intervention, an individualised positive behaviour support plan (PBS plan) is developed and implemented. This multicase study (Stake, 2006) investigated how task engagement was changed for boys from year four to year seven who demonstrated serious, disruptive behaviour. The individualised PBS plan was the primary tool of behaviour intervention in each of the five cases. Using the Behaviour Support Plan Quality Evaluation Scoring Guide II (BSP-QE) (Browning- Wright, Saren & Mayer, 2003) the five PBS plans were evaluated prior to implementation and rated highly in terms of technical quality. Positive changes in student task engagement were forthcoming in all five cases. Eleven advisory visiting teachers in behaviour and eleven classroom teachers, five of whom were case-study participants, took part in this study. The classroom teachers were employed in south-east Queensland primary schools located in suburbs of economic disadvantage. All 22 participants expressed very similar perceptions of serious, disruptive behaviour emphasising the collateral impact upon the teaching and learning. Data obtained through direct observations, surveys and semi-structured interviews confirmed previous research to reveal a strong link between integrity of PBS plan implementation and student behaviour change. While classroom teachers, in the main, effectively managed the implementation of the PBS plan, social validity of goals, procedures and effects; in-class technical assistance and performance feedback were identified as three enablers to effective teacher implementation of the PBS plan. While the purpose of each PBS plan was to influence change in student behaviour, this study found that changing teacher behaviour was also instrumental in achieving positive student outcomes. Changing teacher behaviour and building capacity was facilitated by trusting, collaborative partnerships established between the Advisory Visiting Teacher-Behaviour and the classroom teacher responsible for the plan implementation. The Advisory Visiting Teacher-Behaviour provides assistance to teachers dealing with students who demonstrate ongoing, problematic behaviour. The inclusion of a teaching component as part of the implementation stage of the consultation process appeared to have considerable influence upon successful intervention. Results substantiated earlier understandings of the importance of teacher instruction highlighting the value of explicit teaching and performance feedback to the delivery of effective behaviour intervention. Conclusions drawn from this study have had a major impact upon the work of a regional team of Advisory Visiting Teachers-Behaviour. The focus of behaviour intervention has moved from being primarily upon the individual student to include a greater emphasis upon the critical role of the teacher. Procedures and processes are being re-evaluated to align with evidence-based practice and to include a collaborative consultation approach to improve teacher assistance. The framework and content of staff development and training is being created directly from the findings of this study. This practical application of the results has informed better ways of providing behaviour intervention for students demonstrating serious, disruptive behaviour. What this study has clearly shown is that when it comes to behaviour intervention, the important role of the teacher cannot be underestimated.

What's in it for me? Virtual conspicuous donation strategies as a source of value in blood donation

Providing an incentive is becoming common practice among blood service organisations. Driven by self-orientated motives rather than pure philanthropic intentions, research is showing that people increasingly want something in return for their support. It is contended that individuals donate conspicuously with the hope it will improve their social standing. Yet there is limited evidence for the effectiveness of conspicuous recognition strategies, and no studies, to the researcher’s knowledge, that have examined conspicuous donation strategies in an online social media context. There is a need to understand what value drives individuals to donate blood, and whether conspicuous donation strategies are a source of such value post blood donation. The purpose of this paper is to conceptualise how conspicuous donation strategies, in the form of virtual badges on social media sites, can be applied to the social behaviour of blood donation, as a value-adding tool, to encourage repeat behaviour.

Give some, get some: investigating the relationship between conspicuous donation behaviour on social media and customer value in a blood donation context

Previous research has questioned the role of altruism in charitable donation and suggests that such behaviour is also motivated by self-interest, such as public recognition or emotional satisfaction. Recognising this, not-for-profit organisations have developed strategies that allow individuals to donate conspicuously, and are at an embryonic stage of turning to social media to provide such recognition. Under investigation in this paper, is the relationship between conspicuous donation behaviour (CDB) on social media and customer value, in blood donation. Online survey results, from a sample of 186 Australian blood donors, support the proposed framework. Significant relationships between self-orientated CDB and emotional value, and other-orientated CDB and social value are demonstrated. The findings provide valuable insights into the use of conspicuous donation strategies on social media as a means to add value to the donation experience, and contribute to our understanding into the under-researched areas of CDB and customer value.

Artscience in practice : exploring the critical and creative potentials of transdisciplinary art and science practice using a methodological and conceptual framework of creative becoming

In response to a growing interest in art and science interactions and transdisciplinary research strategies, this research project examines the critical and conceptual affordances of ArtScience practice and outlines a new experiential methodology for practice-lead research using a framework of creative becoming. In doing so, the study contributes to the field of ArtScience and transdisciplinary practice, by providing new strategies for creative development and critical enquiry across art and science.

Defining mega project success in Australian defence : a relation-based framework for value co-creation with project stakeholders

Defining success in mega projects has been a challenging exercise for Australian Defence. The inherent conflict between nation capability building and cost efficiency raises questions about how to appropriately define mega project success. Contrary to the traditional output-focused project methodology, the value creation perspective argues for the importance of creating new knowledge, processes, and systems for suppliers and customers. Stakeholder involvement is important in this new perspective, as the balancing of competing needs of stakeholders in mega projects becomes a major challenge in managing the value co-creation process. In our earlier study reported interview data from three Australian defence mega projects and reported that those senior executives have a more complex understanding of project success than traditional iron triangle measures. In these mega defence projects, customers and other stakeholders actively engage in the value creation process, and over time both content and process value are created to increase defence and national capability. Value created and captured during and post projects are the key to true success. We aim to develop a comprehensive theoretical model the capture the value co-creation process as a way of re-conceptualising success in mega projects. We propose a new framework redefine project value as multi-dimensional, contextual and temporal construct that emerges from the interactions among multiple stake holders over the complete project life cycle. The framework distinguishes between exploitation and exploration types of projects, and takes into consideration the requisite governance structures.

The construction of social identity in new nuclear operators : a longitudinal study

Countless studies have stressed the importance of social identity, particularly its role in various organizational outcomes, yet questions remain as to how identities initially develop, shift and change based on the configuration of multiple, pluralistic relationships grounded in an organizational setting. The interactive model of social identity formation has been proposed recently to explain the internalization of shared norms and values – critical in identity formation – has not received empirical examination. We analyzed multiple sources of data from nine nuclear professionals over three years to understand the construction of social identity in new entrants entering an organization. Informed by our data analyses, we found support for the interactive model and that age and level of experience influenced whether they undertook an inductive or deductive route of the group norm and value internalization. This study represents an important contribution to the study of social identity and the process by which identities are formed, particularly under conditions of duress or significant organizational disruption.

Fashion system Shanghai : the advent of a new gatekeeper

The term fashion system describes inter-relationships between production and consumption illustrating how the production of fashion is a collective activity. For instance, Yuniya Kawamura notes systems for the production of fashion differ around the globe and are subject to constant change, and Jennifer Craik draws attention to an ‘array of competing and intermeshing systems cutting across western and non-western cultures. In China, Shanghai’s nascent fashion system seeks to emulate the Eurocentric system of Fashion Weeks and industry support groups. It promises emergent designers a platform for global competition, yet there are tensions from within. Interaction with a fashion system inevitably means becoming validated or legitimised. Legitimisation in turn depends upon gatekeepers who make aesthetic judgments about the status, quality and cultural value of a designers work. Notwithstanding the proliferation of fashion media, in Shanghai a new gatekeeper has arrived, seeking to filter authenticity from artifice, offering truth in a fashion market saturated with fakery and the hollowness of foreign consumptive practice, and providing a place of sanctuary for Chinese fashion design. Thus this paper discusses how new agencies are allowing designers in Shanghai greater control over their brand image while creating novel opportunities for promotion and sales. It explores why designers choose this new model and provides new knowledge of the curation of fashion by these gatekeepers.

Prognostic value of angiogenesis in operable non-small cell lung cancer

Tumour angiogenesis is an important factor for tumour growth and metastasis. Although some recent reports suggest that microvessel counts in non-small cell lung cancer are related to a poor disease outcome, the results were not conclusive and were not compared with other molecular prognostic markers. In the present study, the vascular grade was assessed in 107 (T1,2-N0,1) operable non-small cell lung carcinomas, using the JC70 monoclonal antibody to CD31. Three vascular grades were defined with appraisal by eye and by Chalkley counting: high (Chalkley score 7-12), medium (5-6), and low (2-4). There was a significant correlation between eye appraisal and Chalkley counting (P < 0.0001). Vascular grade was not related to histology, grade, proliferation index (Ki67), or EGFR or p53 expression. Tumours from younger patients had a higher grade of angiogenesis (P = 0.05). Apart from the vascular grade, none of the other factors examined was statistically related to lymph node metastasis (P < 0.0001). A univariate analysis of survival showed that vascular grade was the most significant prognostic factor (P = 0.0004), followed by N-stage (P = 0.001). In a multivariate analysis, N-stage and vascular grade were not found to be independent prognostic factors, since they were strongly related to each other. Excluding N-stage, vascular grade was the only independent prognostic factor (P = 0.007). Kaplan-Meier survival curves showed a statistically significant worse prognosis for patients with high vascular grade, but no difference was observed between low and medium vascular grade. These data suggest that angiogenesis in operable non-small cell lung cancer is a major prognostic factor for survival and, among the parameters tested, is the only factor related to cancer cell migration to lymph nodes. The integration of vascular grading in clinical trials on adjuvant chemotherapy and/or radiotherapy could substantially contribute in defining groups of operable patients who might benefit from cytotoxic treatment.