Keeping our nursing and midwifery workforce : factors that support non-practising clinicians to return to practice

BACKGROUND: Within Australia and internationally (Health Workforce Australia, 2012) an increasing and on-going nursing workforce shortage is documented. Recent international estimates indicate that there will be ongoing and significant gaps in the supply of a nursing workforce; the United Kingdom is predicted to have a reduction of 12.12% nurses over the coming eight years if a current 'steady state' is maintained (Buchan and Seacombe, 2011); Canada is predicted to have a shortage of 60,000 nurses by 2022 (Tomblin et al., 2012) with Australia's anticipated nursing shortage reported as over 90,000 by the year 2025 (Health Workforce Australia, 2012). Queensland Health in response to their tracked emerging nursing and midwifery workforce shortages developed a nursing and midwifery refresher programme to return registered staff back to the workforce. A study was undertaken between 2008 and 2010 to provide an understanding of how non-practising nurses and midwives maybe supported back into the workforce. METHODS: Programme applicants (444) were invited to respond to an on-line survey designed to understand what aspects of the programme supported their learning and ability to return to the workforce. This number represents those who applied but not all completed or commenced the programme. Descriptive statistics (Polit and Beck, 2008) were used to collate quantifiable survey responses and free text and unsolicited responses were themed. RESULTS: The survey received a 35.5% response rate (n=158) with a return of 20% of unsolicited comments in the form of e-mail responses which were included in the themed results. Key themes supporting participants' learning and ability to return to the workforce were: Respondents were 94% female and 6% male, with 37.7% >51 years of age. Child rearing was the foremost reason for female staff relinquishing workforce roles (36.6%). The primary reason for returning to the workforce was maintenance of registration (40.5%). Both theory and clinical placement components were seen by participants as contributing to their confidence to return to the health workforce. CONCLUSION: The Queensland Nursing and Midwifery Refresher Programs provided a structured programme for registered, non-practising nurses and midwives to return to the Queensland Health workforce. Responses indicated that clinical supervision and contract learning should be central to a return to workforce induction programme for registered but non-practising nurses and midwives. The majority of nurses and midwives returning to the workforce were approaching retirement age in 10-15 years.

Kumarina and bidders voting in transfer schemes

Transfer schemes are an alternative means of acquiring control of a company to making a takeover bid under the provisions in Ch 6 of the Corporations Act 2001 (Cth). The recent decision Re Kumarina Resources Ltd [2013] FCA 549 overturned long-standing practice in relation to a certain type of transfer scheme. If followed, the decision would allow a “bidder” to vote at scheme meetings where the scheme consideration for the acquisition of the target shares are shares in another company, and the scheme results in a merger. But the bidder is not allowed to vote where the scheme consideration is cash. The article points out the difficulties arising from this decision and argues that it should not be followed. In providing a “no objection” statement, the Australian Securities and Investments Commission (ASIC) has created uncertainty as to the approach it will take towards the bidders being allowed to vote at scheme meetings where the scheme consideration for the acquisition of target shares are shares in another company. The article also points out that in providing the no objection statement in Kumarina, ASIC appears to have ignored breaches of s 606(1) of the Corporations Act. There is a pressing need for ASIC to clarify its position and, in particular, whether or not it will provide a no objection statement in respect of future transfer schemes where a bidder (or its parent company) votes at the scheme meeting.

Patient group directions : the application and integration of knowledge in advancing nursing practice

Background: The introduction of Patient Group Directions (PGD) has changed significantly the way in which nurses can now administer prescription only medicines as a one-off for patients requiring this level of service. PGD’s are a written authority to administer drugs to patients that are not identified at the time of treatment. Aim: The aim of this project was to develop a PGD for use within an Outreach team to administer colloid boluses to patients presenting with hypovolemia. Method: Using a case exemplar this paper will discuss the development of a PGD using aspects of transitional change theory to highlight the potential barriers that were encountered. Implications for Practice: The implications for this PGD are wide reaching. First it now enables members from the nursing Outreach team to administer colloid fluid boluses to a prescribed patient cohort without the need for prescription. Second, it ensures the deteriorating patient has interventions initiated in a timely and appropriate manner to reduce inadvertent admission to high care areas. Last, it will improve inter-professional team-working and communication so much so that collaborative patient care reduces health costs and identifies earlier those patients requiring substantially greater nursing and medical input. Conclusion: The experience of developing a working PGD for fluid administration has meant that the Outreach team is able to respond to patients in a more effective way. In addition, it is the experience of developing this PGD that has enabled the team to contemplate other PGD’s in the execution of Outreach work.

Confidence measurement in the light of signal detection theory

We compare three alternative methods for eliciting retrospective confidence in the context of a simple perceptual task: the Simple Confidence Rating (a direct report on a numerical scale), the Quadratic Scoring Rule (a post-wagering procedure), and the Matching Probability (MP; a generalization of the no-loss gambling method). We systematically compare the results obtained with these three rules to the theoretical confidence levels that can be inferred from performance in the perceptual task using Signal Detection Theory (SDT). We find that the MP provides better results in that respect. We conclude that MP is particularly well suited for studies of confidence that use SDT as a theoretical framework.

Wireless Power Transfer (WPT) for electric vehicles (EVs) - present and future trends

100 year old gasoline engine technology vehicles have now become one of the major contributors of greenhouse gases. Plug-in Electric Vehicles (PEVs) have been proposed to achieve environmental friendly transportation. Even though the PEV usage is currently increasing, a technology breakthrough would be required to overcome battery related drawbacks. Although battery technology is evolving, drawbacks inherited with batteries such as; cost, size, weight, slower charging characteristic and low energy density would still be dominating constrains for development of EVs. Furthermore, PEVs have not been accepted as preferred choice by many consumers due to charging related issues. To address battery related limitations, the concept of dynamic Wireless Power Transfer (WPT) enabled EVs have been proposed in which EV is being charged while it is in motion. WPT enabled infrastructure has to be employed to achieve dynamic EV charging concept. The weight of the battery pack can be reduced as the required energy storage is lower if the vehicle can be powered wirelessly while driving. Stationary WPT charging where EV is charged wirelessly when it is stopped, is simpler than dynamic WPT in terms of design complexity. However, stationary WPT does not increase vehicle range compared to wired-PEVs. State-of-art WPT technology for future transportation is discussed in this chapter. Analysis of the WPT system and its performance indices are introduced. Modelling the WPT system using different methods such as equivalent circuit theory, two port network theory and coupled mode theory is described illustrating their own merits in Sect. 2.3. Both stationary and dynamic WPT for EV applications are illustrated in Sect. 2.4. Design challenges and optimization directions are analysed in Sect. 2.5. Adaptive tuning techniques such as adaptive impedance matching and frequency tuning are also discussed. A case study for optimizing resonator design is presented in Sect. 2.6. Achievements by the research community is introduced highlighting directions for future research.

A theory of process modeling impact

Process modeling – the design and use of graphical documentations of an organization’s business processes – is a key method to document and use information about the operations of businesses. Still, despite current interest in process modeling, this research area faces essential challenges. Key unanswered questions concern the impact of process modeling in organizational practice, and the mechanisms through which impacts are developed. To answer these questions and to provide a better understanding of process modeling impact, I turn to the concept of affordances. Affordances describe the possibilities for goal-oriented action that a technical object offers to a user. This notion has received growing attention from IS researchers. The purpose of my research is to further develop the IS discipline’s understanding of affordances and impacts from information objects, such as process models used by analysts for information systems analysis and design. Specifically, I seek to extend existing theory on the emergence, perception and actualization of affordances. I develop a research model that describes the process by which affordances emerge between an individual and an object, how affordances are perceived, and how they are actualized by the individual. The proposed model also explains the role of available information for the individual, and the influence of perceived actualization effort. I operationalize and test this research model empirically, using a full-cycle, mixed methods study consisting of case study and experiment.

Power law distributions in entrepreneurship : implications for theory and research

A long-held assumption in entrepreneurship research is that normal (i.e., Gaussian) distributions characterize variables of interest for both theory and practice. We challenge this assumption by examining more than 12,000 nascent, young, and hyper-growth firms. Results reveal that variables which play central roles in resource-, cognition-, action-, and environment-based entrepreneurship theories exhibit highly skewed power law distributions, where a few outliers account for a disproportionate amount of the distribution's total output. Our results call for the development of new theory to explain and predict the mechanisms that generate these distributions and the outliers therein. We offer a research agenda, including a description of non-traditional methodological approaches, to answer this call.

Reframe QUT's evaluation framework : a case study of planning, policy and positioning leading to educational best practice

Every university in Australia has a set of policies that guide the institution in its educational practices, however, the policies are often developed in isolation to each other. Now imagine a space where policies are evidence-based, refined annually, cohesively interrelated, and meet stakeholders’ needs. Is this happenstance or the result of good planning? Culturally, Queensland University of Technology (QUT) is a risk-averse institution that takes pride in its financial solvency and is always keen to know “how are we going?” With a twenty-year history of annual reporting that assures the quality of course performance through multiple lines of evidence, QUT’s Learning and Teaching Unit went one step further and strategically aligned a suite of policies that take into consideration the needs of their stakeholders, collaborate with other areas across the institution and use multiple lines of evidence to inform curriculum decision-making. In QUT’s experience, strategic planning can lead to policy that is designed to meet stakeholders’ needs, not manage them; where decision-making is supported by evidence, not rhetoric; where all feedback is incorporated, not ignored; and where policies are cohesively interrelated, not isolated. While many may call this ‘policy nirvana’, QUT has positioned itself to demonstrate good educational practice through Reframe, its evaluation framework. In this case, best practice was achieved through the application of a theory of change and a design-led logic model that allows for transition to other institutions with different cultural specificity. The evaluation approach follows Seldin’s (2003) notion to offer depth and breadth to the evaluation framework along with Berk’s (2005) concept of multiple lines of evidence. In summary, this paper offers university executives, academics, planning and quality staff an opportunity to understand the critical steps that lead to strategic planning and design of evidence-based educational policy that positions a university for best practice in learning and teaching.

Practice as Method : The Ex/centric Fixations Project

In this chapter, I consider the efficacy of creative practice as a research method, concentrating specifically on its applications in the performing arts, using one of my own recent projects, The Ex/centric Fixations Project (2009), as an example.

Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses

Background Improving hand hygiene among health care workers (HCWs) is the single most effective intervention to reduce health care associated infections in hospitals. Understanding the cognitive determinants of hand hygiene decisions for HCWs with the greatest patient contact (nurses) is essential to improve compliance. The aim of this study was to explore hospital-based nurses’ beliefs associated with performing hand hygiene guided by the World Health Organization’s (WHO) 5 critical moments. Using the belief-base framework of the Theory of Planned Behaviour, we examined attitudinal, normative, and control beliefs underpinning nurses’ decisions to perform hand hygiene according to the recently implemented national guidelines. Methods Thematic content analysis of qualitative data from focus group discussions with hospital-based registered nurses from 5 wards across 3 hospitals in Queensland, Australia. Results Important advantages (protection of patient and self), disadvantages (time, hand damage), referents (supportive: patients, colleagues; unsupportive: some doctors), barriers (being too busy, emergency situations), and facilitators (accessibility of sinks/products, training, reminders) were identified. There was some equivocation regarding the relative importance of hand washing following contact with patient surroundings. Conclusions The belief base of the theory of planned behaviour provided a useful framework to explore systematically the underlying beliefs of nurses’ hand hygiene decisions according to the 5 critical moments, allowing comparisons with previous belief studies. A commitment to improve nurses’ hand hygiene practice across the 5 moments should focus on individual strategies to combat distraction from other duties, peer-based initiatives to foster a sense of shared responsibility, and management-driven solutions to tackle staffing and resource issues. Hand hygiene following touching a patient’s surroundings continues to be reported as the most neglected opportunity for compliance.

Career counseling : joint contributions of contextual action theory and the systems theory framework

The influence of constructivism and the ongoing drive for convergence, both of career theories and between theory and practice, have been key drivers in the career development literature for two decades (Patton, International Handbook of Career Guidance, 2008). Both contextual action theory and systems theory are derived from the root metaphor of contextualism, which has been proffered as a worldview to assist scientists and practitioners in organizing day-to-day experiential data. This chapter identifies the theoretical contributions of the Systems Theory Framework (STF) (Patton and McMahon, Career development and systems theory: A new development, 1999, Career psychology in South Africa, 2006) and Contextual Action Theory (Young and Valach, The future of career, 2000, Journal of Vocational Behavior 64:499–514, 2004; Young et al., Career choice and development, 1996, Career choice and development, 2002), each of which has advanced thinking in theory integration and in the integration between theory and practice in the career development and counseling field. Young et al. (Career development in childhood and adolescence, 2007) noted the connections between the Patton and McMahon systems theory approach and the contextual action theory approach and these connections will be highlighted in terms of the application of these theoretical developments to practice in career counseling, with a particular focus on the commonalities between the two approaches and what counselors can learn from each of them. In particular, this chapter will discuss common conceptual understandings and practice dimensions.

Playing Pranks: Traditions, communities & co-creative cultural performance practice

Pranks, hoaxes and practical jokes are co-creative cultural performance practices that appear across times, contexts and cultures. These practices include everyday play amongst families, friends and coworkers, entertainment programs such as Prank Patrol, Punked or Scare Tactics, and aesthetic and activist pranks perpetrated by situationist artists, guerrilla artists, and, most recently, culture ‘jammers’ or ‘hackers’ intent on turning capitalist systems back on themselves. Although it can, in common usage, describe almost any show off behaviour, a prank in the strictest definition of the term is a performance that deploys a very specific set of strategies. It is an act of trickery, mischief, or deceit, that must be taken as real, and momentarily cause real fear, anger or worry for an unwitting spectator-become-performer, who is meant to play along until the trick is revealed and their response can be represented back to the prankster, other spectators, or society as a whole, either for the sake of entertainment or for the sake of commentary on a cultural phenomenon. A prank, in this sense, deliberately blurs the boundaries between daily and dramatic performance. It creates a moment of uncertainty, in which both the prankster’s ability to be creative, clever, or culturally astute, and the prankee’s ability to play along, discern the trick, discern the point of the trick, and, in the end, be duped, be a good sport, or even play/pay the prankster back, are both put to the test. In this paper, I consider a number of pranking traditions popular where I am in Australia, from the community-building pranks of footballers, bucks parties and ‘drop bear’ tales told to tourists, to the more controversial pranks of radio shock jocks, activists and artists. I use performance, spectatorship and ethical theory to examine the engagement between prankster, pranked spectator, and other spectators, in this most distinctive sort of community-driven performance practice, and the way it builds and breaks status, social and other sorts of relationships within and between specific communities.

Double blind: Supervising women as creative practice-led researchers

Many women creative practice-led researchers appear inhibited by a number of factors directly connected to their gender. This paper discusses these factors, including the culture of visual arts professional practice, the circumstances surrounding women postgraduate students, and unproductive self-theories about intelligence and creativity. A number of feminist strategies are discussed as potential interventions that may assist women creative practice-led researchers and their supervisors to reap more personal and professional rewards from their postgraduate research.

A taste of best practice in engineering sustainable solutions

This paper asks the question to what scale and speed does society need to reduce its ecological footprint and improve resource productivity to prevent further overshoot and return within the ecological limits of the earth’s ecological life support systems? How fast do these changes need to be achieved? The paper shows that now a large range of studies find that engineering sustainable solutions need to be roughly an order or magnitude resource productivity improvement (sometimes called a Factor of 10, or a 90% reduction) by 2050 to achieve real and lasting ecological sustainability. This marks a significant challenge for engineers – indeed all designers and architects, where best practice in engineering sustainable solutions will need to achieve large resource productivity targets. The paper brings together examples of best practice in achieving these large targets from around the world. The paper also highlights key resources and texts for engineers who wish to learn how to do it. But engineers need to be realistic and patient. Significant barriers exist to achieving Factor 4-10 such as the fact that infrastructure and technology rollover and replacement is often slow. This slow rollover of the built environment and technology is the context within which most engineers work, making the goal of achieving Factor 10 all the more challenging. However, the paper demonstrates that by using best practice in engineering sustainable solutions and by addressing the necessary market, information and institutional failures it is possible to achieve Factor 10 over the next 50 years. This paper draws on recent publications by The Natural Edge Project (TNEP) and partners, including Hargroves, K. Smith, M. (Eds) (2005) The Natural Advantage of Nations: Business Opportunities, Innovation and Governance for the 21st Century, and the TNEP Engineering Sustainable Solutions Program - Critical Literacies for Engineers Portfolio. Both projects have the significant support of Engineers Australia. its College of Environmental Engineers and the Society of Sustainability and Environmental Engineering.

Making the profitable transition towards sustainable business practice

The last three decades have been difficult for companies and industry. In an increasingly competitive international business climate with shifting national environmental regulations, higher standards are being demanded by the consumer and community groups, not-to-mention the escalating cost of primary resources such as water, steel and minerals. The cause of these pressures is the traditional notion held by business executives and engineers that there is an inherent trade off between eco-efficiency and improving the economic bottom line. However there is significant evidence and examples of best practice to show that there is in fact no trade-off between the environment and the economy if sustainable development through continual improvement is adopted. It is highly possible therefore for companies to make a profitable transition towards sustainable business practice, where along the transition significant business opportunities can be taken advantage of. Companies are by their very nature dynamic, influential and highly capable of adapting to change. Making an organisational transformation to a sustainable business is not outside the capacity of the typical company, who know much of what is needed already to change their activities to satisfy current market demands while achieving competitiveness. However in order to make the transition towards sustainable business practice companies require some key mechanisms such as accurate information on methodologies and opportunities, understanding of the financial and non-financial incentives, permission from stakeholders and shareholders, understanding of the emerging market opportunities, a critical mass of leaders in their sector and demonstrated case studies, and awarding appropriate risk-taking activities undertaken by engineers and CEOs. Satisfying these requirements will adopt an innovative culture within the company that strives for continual improvement and successfully transforms itself to achieve competitiveness in the 21st Century. This paper will summarise the experiences of The Natural Edge Project (TNEP) and its partners in assisting organisations to make a profitable transition towards sustainable business practice through several initiatives. The Natural Advantage of Nations publication provides the critical information required by business leaders and engineers to set the context of sustainable business practice. The Profiting in a Carbon Constrained World report, developed with Natural Capitalism Inc led by Hunter Lovins, summarises the opportunities available to companies to take advantage of the carbon trading market mechanisms such as the Chicago Climate Exchange and European Climate Exchange. The Sustainability Helix then guides the company through the transition by identifying the key tools and methodologies required by companies to reduce environmental loading while dramatically improving resource productivity and achieving competitiveness. Finally, the Engineering Sustainable Solutions Program delivers the key engineering information required by companies and university departments to deliver sustainable engineering solutions. The initiatives are of varying complexity and level of application, however all are designed to provide key staff the critical information required to make a profitable transition towards sustainable business practice. It is then their responsibility to apply and teach their knowledge to the rest of the organisation.