An exploratory study of staff nurses' knowledge of delirium in the medical ICU: An Asian perspective

Aim The aim of this study was to establish intensive care unit nurses’ knowledge of delirium within an acute tertiary hospital within South East Asia. Background Delirium is a common, life threatening and often preventable cause of morbidity and mortality among older patients. Undetected and untreated delirium is a catalyst to increased mortality, morbidity, functional decline and results in increased requirement for nursing care, healthcare expense and hospital length of stay. However, despite effective assessment tools to identify delirium in the acute setting, there still remains an inability of ICU nurses’ to accurately identify delirium in the critically ill patient especially that of hypoactive delirium. Method A purposive sample of 53 staff nurses from a 13-bedded medical intensive care unit within an acute tertiary teaching hospital in South East Asia were asked to participate. A 40 item 5-point Likert scale questionnaire was employed to determine the participants’ knowledge of the signs and symptoms; the risk factors and negative outcomes of delirium. Results The overall positively answered mean score was 27 (67.3%) out of a possible 40 questions. Mean scores for knowledge of signs and symptoms, risk factors and negative outcomes were 9.52 (63.5%, n = 15), 11.43 (63.5%, n = 17) and 6.0 (75%, n = 8), respectively. Conclusion Whilst the results of this study are similar to others taken from a western perspective, it appeared that the ICU nurses in this study demonstrated limited knowledge of the signs and symptoms, risk factors and negative outcomes of delirium in the critically patient. The implications for practice of this are important given the outcomes of untreated delirium.

Advancing Nursing Practice in Pain Management

This book showcases the development and evaluation of innovative examples of pain management initiatives by advanced practitioners. It considers each service development or community initiative both in terms of advanced practice nursing and pain management. There is a wide range of examples of innovation in pain management included - from the introduction of ketamine use in one trust, to wider issues around meeting the needs of pain management in the community. The book considers issues including use of research, education and interprofessional working in the advanced practitioner role. Each chapter looks at development of the service, challenges of implementation, evaluation of the service's success and justifying the importance of the advanced nurse in the service's achievements.

Introduction to Advancing Practice in Pain Management

This chapter contains sections titled: Introduction Advanced practice The context of pain management: definitions and prevalence Advancing practice in pain management Bringing together advanced practice and pain management Conclusions References

Nurse Prescribing in Acute and Chronic Pain Management

This chapter contains sections titled: Introduction Acute pain Chronic pain Rationale for service development Evaluation use of audit and CPD Justifying the advanced nursing contribution to develop nurse prescribing in pain management Conclusions References

New Knowledge for Advancing Practice in Pain Management

This chapter contains sections titled: Introduction Advancing practice in pain management Conclusions References

A novel, automated nutrition screening system as a predictor of nutritional risk in an oncology day treatment unit (ODTU)

Purpose Paper-based nutrition screening tools can be challenging to implement in the ambulatory oncology setting. The aim of this study was to determine the validity of the Malnutrition Screening Tool (MST) and a novel, automated nutrition screening system compared to a ‘gold standard’ full nutrition assessment using the Patient-Generated Subjective Global Assessment (PG-SGA). Methods An observational, cross-sectional study was conducted in an outpatient oncology day treatment unit (ODTU) within an Australian tertiary health service. Eligibility criteria were as follows: ≥18 years, receiving outpatient anticancer treatment and English literate. Patients self-administered the MST. A dietitian assessed nutritional status using the PGSGA, blinded to the MST score. Automated screening system data were extracted from an electronic oncology prescribing system. This system used weight loss over 3 to 6 weeks prior to the most recent weight record or age-categorised body mass index (BMI) to identify nutritional risk. Sensitivity and specificity against PG-SGA (malnutrition) were calculated using contingency tables and receiver operating curves. Results There were a total of 300 oncology outpatients (51.7 % male, 58.6±13.3 years). The area under the curve (AUC) for weight loss alone was 0.69 with a cut-off value of ≥1 % weight loss yielding 63 % sensitivity and 76.7 % specificity. MST (score ≥2) resulted in 70.6 % sensitivity and 69.5 % specificity, AUC 0.77. Conclusions Both the MST and the automated method fell short of the accepted professional standard for sensitivity (~≥80 %) derived from the PG-SGA. Further investigation into other automated nutrition screening options and the most appropriate parameters available electronically is warranted to support targeted service provision.

Prevalence of undiagnosed urinary tract infections on admission to a rehabilitation unit

Background Through clinical observation nursing staff of an inpatient rehabilitation unit identified a link between incontinence and undiagnosed urinary tract infections (UTIs). Further, clinical observation and structured continence management led to the realisation that urinary incontinence often improved, or resolved completely, after treatment with antibiotics. In 2009 a small study found that 30% of admitted rehabilitation patients had an undiagnosed UTI, with the majority admitted post-orthopaedic fracture. We suspected that the frequent use of indwelling urinary catheters (IDCs) in the orthopaedic environment may have been a contributing factor. Therefore, a second, more thorough, study was commenced in 2010 and completed in 2011. Aim The aim of this study was to identify what proportion of patients were admitted to one rehabilitation unit with an undiagnosed UTI over a 12-month period. We wanted to identify and highlight the presence of known risk factors associated with UTI and determine whether urinary incontinence was associated with the presence of UTI. Methods Data were collected from every patient that was admitted over a 12-month period (n=140). The majority of patients were over the age of 65 and had an orthopaedic fracture (36.4%) or stroke (27.1%). Mid-stream urine (MSU) samples, routinely collected and sent for culture and sensitivity as part of standard admission procedure, were used by the treating medical officer to detect the presence of UTI. A data collection sheet was developed, reviewed and trialled, before official data collection commenced. Data were collected as part of usual practice and collated by a research assistant. Inferential statistics were used to analyse the data. Results This study found that 25 (17.9%) of the 140 patients admitted to rehabilitation had an undiagnosed UTI, with a statistically significant association between prior presence of an IDC and the diagnosis of UTI. Urinary incontinence improved after the completion of treatment with antibiotics. Results further demonstrated a significant association between the confirmation of a UTI on culture and sensitivity and the absence of symptoms usually associated with UTI, such as burning or stinging on urination. Overall, this study suggests careful monitoring of urinary symptoms in patients admitted to rehabilitation, especially in patients with a prior IDC, is warranted.

Negotiating the creative and the critical : Paul Dawson’s creative writing and the new humanities

In the first Modern Language Association newsletter for 2006, renowned poetry critic and MLA President, Marjorie Perloff, remarked on the growing ascendency of Creative Writing within English Studies in North America. In her column, Perloff notes that "[i]n studying the English Job Information List (JIL) so as to advise my own students and others I know currently on the market, I noticed what struck me as a curious trend: there are, in 2005, almost three times as many positions in creative writing as in the study of twentieth-century literature" (3). The dominance of Creative Writing in the English Studies job list in turn reflects the growing student demand for undergraduate and postgraduate degrees in the field—over the past 20 years, BA and MA degrees in Creative Writing in North American tertiary institutions have quadrupled (3)...

Clinician-driven automated classification of limb fractures from free-text radiology reports

The aim of this research is to report initial experimental results and evaluation of a clinician-driven automated method that can address the issue of misdiagnosis from unstructured radiology reports. Timely diagnosis and reporting of patient symptoms in hospital emergency departments (ED) is a critical component of health services delivery. However, due to disperse information resources and vast amounts of manual processing of unstructured information, a point-of-care accurate diagnosis is often difficult. A rule-based method that considers the occurrence of clinician specified keywords related to radiological findings was developed to identify limb abnormalities, such as fractures. A dataset containing 99 narrative reports of radiological findings was sourced from a tertiary hospital. The rule-based method achieved an F-measure of 0.80 and an accuracy of 0.80. While our method achieves promising performance, a number of avenues for improvement were identified using advanced natural language processing (NLP) techniques.

Dancing to too many tunes : contemporary course design in teacher education

Contemporary course designers in schools and faculties of Education are finding themselves dancing to many tunes, arguably too many tunes, in order to have their initial teacher education courses accredited by external agencies whilst satisfying internal approval processes and, critically, maintaining the philosophical integrity of their programs and their institutional watermarks. The “tunes” here are the agendas driven by and the demands made by distinct independent agencies. The external agencies influencing Education include: TEQSA (Tertiary Education Quality and Standards Agency) which will assure alignment to the AQF (Australian Qualifications Framework); professional bodies such as AITSL (Australian Institute for Teaching and School Leadership) which now accredits all pre-service teacher Education courses across Australia and assures alignment with the Australian Professional Standards for Teachers; and the state and territory regulatory authorities that have an impact within a specific jurisdiction, for example, the Queensland College of Teachers (QCT) and the Teacher Registration Board of Western Australia (TRBWA). This paper – whose findings have been arrived at through a year-long OLT National Teaching Fellowship - will outline the complex and competing agendas currently at play and focus on the disjuncture evident in the fundamental defining of who is a “graduate.” It will also attempt to identify where there are synergies between the complex demands being made. It will argue that there are too many “tunes” and the task of finding a balance between compliance and delivering effective initial teacher education may not be possible because of the cacophony of their conflicting demands.

Circle Stories

Research background: Circle Stories was a live performance curated by Brydie-Leigh Bartleet, Naomi Sunderland, Gavin Carfoot and the Winanjjikari Music Centre as part of the Desert Harmony Festival 2013. The performance was the culmination of five years of research into intercultural performing arts practice, undertaken in partnership with Barkly Regional Arts. This work has built on existing scholarly work in community service learning by Marilynne Boyle-Baise, approaches to intercultural music making with Australian First Peoples by Karl Neuenfeldt, and studies of Indigenous popular music by Peter Dunbar-Hall and Chris Gibson. The performance followed the popular songwriters’ circle approach, in which Aboriginal musicians and elders presented their songs along with tertiary music students, as part of a broader dialogue with each other and the audience. Each performance provided an opportunity to highlight the importance of music in the development of intercultural knowledge and understanding. The project asked the research question, how can collaborative music performance foster mutual learning, intercultural knowledge and reconciliation? Research contribution: The project development and performance of Circle Stories identified that mutual learning and intercultural knowledge can result most effectively through long-term and meaningful relationships underpinning collaborative creative practice. Research significance: Following a general call for proposals, the performance was peer reviewed and selected for inclusion in the Desert Harmony Festival program. The research context of the work is detailed in Brydie-Leigh Bartleet and Gavin Carfoot 2013. "Desert harmony: Stories of collaboration between Indigenous musicians and university students." International Education Journal: Comparative Perspectives 12 (1): 180-196.

The importance of understanding student learning styles in accounting degree programs

Accounting education is critical and any improvements in tertiary education of accounting students should result in better prepared graduates entering the profession. This study evaluates accounting students’ learning styles and the interaction of learning styles and teaching methodologies during degree programmes. Nine classes of accounting students (648 students) spread across four years and two degree programmes were evaluated. Students self-evaluated their learning style, pre-instruction. They were then subject to two separate teaching techniques (one active and one passive) in each course. Learning styles were then re-assessed and teaching techniques evaluated. Accounting students displayed a preference for passive learning, even those far advanced in their degrees. Furthermore, when learning styles matched teaching methods used, usefulness was assessed as high but when learning styles and teaching methods differed, usefulness deteriorated. Overall, the teaching methods were deemed more effective by active rather than passive learners. The implications are significant. To maximise educational benefit for the accounting profession, student learning styles should be assessed before designing appropriate teaching methodologies. This has resource implications which would have to be considered.

ortho-Bromo(propa-1,2-dien-1-yl)arenes : substrates for domino reactions

o-Bromo(propa-1,2-dien-1-yl)arenes exhibit novel and orthogonal reactivity under Pd catalysis in the presence of secondary amines to form enamines (concerted Pd insertion, intramolecular carbopalladation, and terminative Buchwald–Hartwig coupling) and of amides to form indoles (addition, Buchwald–Hartwig cyclization, and loss of the acetyl group). The substrates for these reactions can be accessed in a reliable and highly selective two-step process from 2-bromoaryl bromides.

Teaching colour theory online : challenges, opportunities and experiences [Abstract]

Over the past decade, various paradigm shifts and challenges have rapidly changed learning and teaching in higher education including meeting student expectation for more engaging, more interactive learning experiences, the increased focus in the tertiary sector to deliver content online, and dealing with the complexities of fast-changing technologies. Rising to these challenges and responding to them is a complex and multi-faceted task. This paper discusses a case study undertaken applying a framework drawn from engineering education teaching and learning methods using the concept of academagogy, which is learner-centric, actively empowering students in building effective learning and engages facilitators in meaningful teaching and delivery methods.

The power of naming : the multifaceted value of learning students’ names

The modern day Australian law school is expected to educate and engage law students. Ideally law school will instil a sense of passion (or at least appreciation) for the law, promote a positive professional identity, foster a sense of community, and provide general support to law students. Collectively, the Australian legal academy is struggling with these goals. Significant numbers of students feel isolated, disconnected and unengaged throughout their tertiary legal education. Teaching students from increasingly diverse backgrounds, who spend less time on campus and less face-to-face time in class, many law academics feel ill-equipped to respond to the challenge of engaging law students in time and cost efficient ways. Intentionally learning and using student names has potential to humanise the law school experience, build community, and positively impact upon the wellbeing of students and staff.