Historical evolution and modern implications of concepts of consent to, and refusal of, medical treatment in the law of trespass

Many mischiefs arise on the change of a maxim and rule of the Common Law, which those who altered it could not see when they made the change.

History, memory, and the politics of programming : the video work of Richard Fung

Richard Fung, a Toronto-based video artist and cultural critic, was born in Trinidad in 1954, and attended school in Ireland before immigrating to Canada to study at the University of Toronto. Richard Fung has taught at the Ontario College of Art and Design, and has been a visiting professor in the Department of Media Study at the State University of New York in Buffalo. He is currently the coordinator of the Centre for Media and Culture in Education, Ontario Institute for Studies in Education, University of Toronto.

Implementing elements of Schon's reflective practitioner in an undergraduate public relations program

While the internship unit in a public relations degree is often viewed as the foremost area of experiential learning it can fail to deliver significant learning outcomes for student and teacher. This paper explores the use of other activity-based learning (ABL) methods as implemented in the Deakin University public relations undergraduate degree. The paper applies Donald Schon's concept of the reflective practitioner to learning undertaken in an internship unit and compares this application to two other units where ABL is used and the focus is on creating a client-professional relationship. For the purpose of this paper information was analysed using the 2006 on-campus cohort only. The cohort was further refined to include those students who successfully completed the degree of BA in public relations. Student internship evaluation forms and unit records were viewed to gain statistical information.

The reliability of performance of healthy adults on three visual perception tests

Problems with visual perceptual skills have been shown to have a negative impact on the daily living skills of individuals and are, therefore, commonly assessed by occupational therapists. The purpose of this study was to examine two types of reliability (internal consistency and test-retest reliability) of three newly revised or developed adult visual perception tests. The participants were 50 healthy adults, aged 18 to 55 years, from Melbourne, Victoria, Australia. The participants completed the Developmental Test of Visual Perception - Adolescent and Adult (DTVP-A), the Motor-Free Visual Perception Test - Third Edition (MVPT-3) and the Test of Visual Perceptual Skills (non-motor) - Third Edition (TVPS-3). Internal consistency was examined using Cronbach's alpha calculations and test-retest reliability was analysed using Spearman rho non-parametric correlation coefficients.

The results indicated that the DTVP-A, the MVPT-3 and the TVPS-3 had total scale internal consistency correlation scores of 0.60 or higher (0.60, 0.69 and 0.63 respectively). The majority of the subscales of each test had lower correlation coefficients than the overall scores (ranging from 0.22 to 0.49). For the DTVP-A, MVPT-3 and TVPS-3 total scale scores, the test-retest reliability correlation coefficients were statistically significant (rho = 0.46, p<0.05; rho = 0.62, p<0.01; and rho = 0.59, p<0.01, respectively). Overall, the three visual perceptual tests exhibited low to moderate levels of internal consistency and test-retest reliability.

Implementation of evidence into practice : Development of a tool to improve emergency nursing care of acute stroke

Background
Stroke is an increasing global health issue that places considerable burden on society and health care services. An important part of acute stroke management and decreasing stroke-related mortality is preventing complications within the first 24–48 hours. The current climate of prolonged time spent in the Emergency Department (ED) means that many aspects of stroke management are now the responsibility of emergency nurses.

Aims
The aims of this paper are to: i) examine the evidence related to nursing care of acute stroke, ii) identify evidence-based elements of stroke care with most applicability to emergency nursing and iii) use evidence-based stroke care recommendations to develop a guideline for the emergency nursing management of acute stroke.

Results
Emergency nursing care of acute stroke should focus on optimal triage decisions, physiological surveillance, fluid management, risk management, and early referral to specialists.

Conclusions
The role of emergency nurses in stroke care will increase and it is important that emergency nurses deliver evidence-based stroke care in order to optimise patient outcomes. Guidelines and decision support tools for use in emergency nursing must be practical and have high levels of clinical utility for maximum uptake in a busy clinical environment.

Generation of statements for the development of clinical indicators for mental heath nursing in New Zealand : achieving a bicultural focus

Aim : In this paper, the first of 4 stages of a large study aiming to develop culturally and clinically valid clinical indicators to flag the achievement of mental health nursing standards of practice in New Zealand are described.

Methods : A bicultural design was employed throughout the research project to ensure that nurses' views of practice and the cultural differences between New Zealand's indigenous Maori and non-Maori peoples could be identified. Accordingly, separate focus groups of Maori- and non-Maori-experienced mental health nurses were asked to develop lists of statementd reflective of the Australian and New Zealand College of Mental Health Nurses' Standards of Practice in New Zealand.

Results : The focus group participants produces 473 statements, which were synthesized into 190 clinical indicator statements. In keeping with the bicultural research design, Maori and non-Maori data were analysed separately until the data were merged to provide a single set of indicator statements. Although both Maori and non-Maori groups wrote statements relevant to clinical practice, there was a difference in the way the 2 groups addressed cultural issues. The Maori focus group wrote statements about cultural issues for 4 of the 6 Standards of Practice, whereas the non-Maori focus group participants wrote statements about cultural issues for only the Standard focusing on cultural safety.

Conclusion : The research design of this project in mental health nursing was unique in that it sought the perspectives of both indigenous and non-indigenous nurses about quality mental health nursing practice related to the professional standards of practice. The involvement of Maori and non-Maori mental health nurses enhanced the cultural and clinical validity of the study and the obtained from it. The bicultural approach adopted for the study highlights the need for more mental health nursing research involving indigenous partners.

Interventions for reducing the use of seclusion in psychiatric facilities : a review of the literature

Background The authors of a recent systematic review concluded that the use of non-pharmacological containment methods, excluding restraint and seclusion, was not supported by evidence. Their focus on randomised, controlled trials, however, does not reflect the research that has been, or could be, conducted.

Aims To find empirically supported interventions that allow reduction in the use of seclusion in psychiatric facilities.

Method We reviewed English-language, peer-reviewed literature on interventions that allow reduction in the use of seclusion.

Results Staff typically used multiple interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement, increased staff to patient ratios, monitoring seclusion episodes, psychiatric emergency response teams, staff education, monitoring of patients, pharmacological interventions, treating patients as active participants in seclusion reduction interventions, changing the therapeutic environment, changing the facility environment, adopting a facility focus, and improving staff safety and welfare.

Conclusions Reducing seclusion rates is challenging andgenerally requires staff to implement several interventions.

The use of scoring rubrics to determine clinical performance in the operating suite

Summary : This research evolved out of the need to examine the validity and inter-rater reliability of a set of performance-based scoring rubrics designed to measure competencies within the operating suite.

Method : Both holistic and analytical rubrics were developed aligned to the ACORN Standard [Australian College of Operating Room Nurses Standard NR4, 2004. ACORN Competency Standards for Perioperative Nurses: Standard NR4: The Instrument Nurse in the Perioperative Environment. Australian College of Operating Room Nurses Ltd, Adelaide] and underpinned by the Dreyfus model (1981). Three video clips that captured varying performance of nurses performing as instrument nurses in the operating suite were recorded and used as prompts by expert raters, who judged the performance using the rubrics.

Results : The study found that the holistic rubrics led to more consistent judgments than the analytical rubrics, yet the latter provided more diagnostic information for intervention purposes. Despite less consistency, the Analytical Observation Form had sufficient construct validity to satisfy the requirements of criterion referencing as determined by the Item Separation Index (Rasch, 1960), including high internal consistency and greater inter-rater reliability when average ratings were used.

Conclusion : The study was an empirical investigation of the use of concomitant Analytical and Holistic Rubrics to determine various levels of performance in the operating suite including inter-rater reliability. The methodology chosen was theoretically sound and sufficiently flexible to be used to develop other competencies within the operating suite.

Evaluating quality of life in hip and knee replacement: psychometric properties of the World Health Organization Quality of Life short version instrument

Objective: To evaluate the psychometric properties of the World Health Organization Quality of Life short version instrument (WHOQOL-BREF), and to determine its responsiveness in assessing early outcome after total hip or knee replacement surgery.

Methods: At baseline (entry to an orthopedic waiting list), 279 participants completed the WHOQOL-BREF instrument, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Assessment of Quality of Life (AQOL) instrument, Kessler Psychological Distress (K10) scale, and the modified Health Assessment Questionnaire (MHAQ). A total of 74 patients completed reassessments 3 months after surgery.

Results: The WHOQOL-BREF demonstrated acceptable internal consistency for all domains (Cronbach's = 0.76-0.84) and moderate concurrent validity for the physical and psychological domains (r = 0.67 for physical versus AQOL; r = -0.71 for psychological versus K10). Minimal ceiling or floor effects were identified at baseline or 3 months, except for the social relationships domain. The disease-specific WOMAC subscales were most responsive to change (relative efficiency [RE] 0.66-1.00). Apart from social relationships, all WHOQOL-BREF scores improved significantly after surgery. The physical domain was more responsive than the AQOL (RE 0.50 versus 0.42) and was similar to the MHAQ (RE 0.55 for MHAQ). The responsiveness of the psychological domain was similar to that of the K10 scale (RE 0.11 versus 0.08).

Conclusion: The WHOQOL-BREF has good psychometric properties for use in persons with severe joint disease, and by providing complementary information, it offers clinicians and researchers an additional tool for comprehensively assessing quality of life in this patient group.