The impact of surgical ward nurses practicing respiratory assessment on positive patient outcomes

Objective: A literature review to examine the incorporation of respiratory assessment into everyday surgical nursing practice; possible barriers to this; and the relationship to patient outcomes. Primary argument: Escalating demands on intensive care beds have led to highly dependent patients being cared for in general surgical ward areas. This change in patient demographics has meant the knowledge and skills required of registered nurses in these areas has expanded exponentially. The literature supported the notion that postoperative monitoring of vital signs should include the fundamental assessment of respiratory rate; depth and rhythm; work of breathing; use of accessory muscles and symmetrical chest movement; as well as auscultation of lung fields using a stethoscope. Early intervention in response to changes in a patient's respiratory health status impacts positively on patient health outcomes. Substantial support exists for the contention that technologically adept nurses who also possess competent respiratory assessment skills make a difference to respiratory care. Conclusions: Sub-clinical respiratory problems have been demonstrated to contribute to adverse events. There is a paucity of research knowledge as to whether respiratory education programs and associated inservice make a difference to nursing clinical practice. Similarly, the implications for associated respiratory educational needs are not well documented, nor has a research base been sufficiently developed to guide nursing practice. Further research has the potential to influence the future role and function of the registered nurse by determining the importance of respiratory education programs on post-operative patient outcomes.

International conventions and model laws : their impact on domestic commercial law

Panellist commentary on delivered conference papers on the topic of ‘International Conventions and Model Laws - Their Impact on Domestic Commercial Law’.

Life impact of ankle fractures : qualitative analysis of patient and clinician experiences

Background: Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them. Methods: A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12) who had previously sustained an ankle fracture (patients) and health professionals (n=6) that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers. Results: Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1), physiotherapists (3), a podiatrist (1) and an occupational therapist (1). The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking). Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes. Conclusions: The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived framework from which a condition-specific patient-reported outcome measure can be developed.

Mobile valuations : the Internet's impact on traditional valuation services

Preparing valuations is a time consuming process involving site inspections, research and report formulation. The ease of access to the internet has changed how and where valuations may be undertaken. No longer is it necessary to return to the office to finalise reports, or leave your desk in order to undertake research. This enables more streamlined service delivery and is viewed as a positive. However, it is not without negative impacts. This paper seeks to inform practitioners of the work environment changes flowing from increased access to the internet. It identifies how increased accessibility to, and use of, technology and the internet has, and will continue to, impact upon valuation service provision into the future.

Numerical study of impact forces on railway sleepers under wheel flat

Wheel-rail interaction is one of the most important research topics in railway engineering. It includes track vibration, track impact response and safety of the track. Track structure failures caused by impact forces can lead to significant economic loss for track owners through damage to rails and to the sleepers beneath. The wheel-rail impact forces occur because of imperfections on the wheels or rails such as wheel flats, irregular wheel profile, rail corrugation and differences in the height of rails connected at a welded joint. The vehicle speed and static wheel load are important factors of the track design, because they are related to the impact forces under wheel-rail defects. In this paper, a 3-Dimensional finite element model for the study of wheel flat impact is developed by use of the FEA software package ANSYS. The effects of the wheel flat to impact force on sleepers with various speeds and static wheel loads under a critical wheel flat size are investigated. It has found that both wheel-rail impact force and impact force on sleeper induced by wheel flat are varying nonlinearly by increasing the vehicle speed; both impact forces are nonlinearly and monotonically increasing by increasing the static wheel load. The relationships between both of impact forces induced by wheel flat and vehicles speed or static load are important to the track engineers to improve the design and maintenance methods in railway industry.

A dynamic wheel-rail impact analysis of railway track under wheel flat by Finite Element Analysis

Wheel–rail interaction is one of the most important research topics in railway engineering. It involves track impact response, track vibration and track safety. Track structure failures caused by wheel–rail impact forces can lead to significant economic loss for track owners through damage to rails and to the sleepers beneath. Wheel–rail impact forces occur because of imperfections in the wheels or rails such as wheel flats, irregular wheel profiles, rail corrugations and differences in the heights of rails connected at a welded joint. A wheel flat can cause a large dynamic impact force as well as a forced vibration with a high frequency, which can cause damage to the track structure. In the present work, a three-dimensional (3-D) finite element (FE) model for the impact analysis induced by the wheel flat is developed by use of the finite element analysis (FEA) software package ANSYS and validated by another validated simulation. The effect of wheel flats on impact forces is thoroughly investigated. It is found that the presence of a wheel flat will significantly increase the dynamic impact force on both rail and sleeper. The impact force will monotonically increase with the size of wheel flats. The relationships between the impact force and the wheel flat size are explored from this finite element analysis and they are important for track engineers to improve their understanding of the design and maintenance of the track system.

Does residential dissonance impact residential mobility?

This research identifies residential mobility behaviour impacts of residential dissonance in Transit Oriented Developments (TODs) vs. non-TODs in Brisbane, Australia. Based on the characteristics of living environments (density, diversity, connectivity, and accessibility) and the travel preferences of 4545 individuals, respondents in 2009 were classified into one of four categories including: TOD consonants, TOD dissonants, non-TOD dissonants, and non-TOD consonants. Binary logistic regression analyses were employed to identify residential mobility behaviour of groups between 2009 and 2011; controlling for time varying covariates. The findings show that both TOD dissonants and TOD consonants move residences at an equal rate. However, TOD dissonants are more likely to move residences to their preferred non-TOD areas. In contrast, non-TOD dissonants not only moved residences at a lower rate, but their rate of mobility to their preferred TOD neighbourhood is also significantly lower due to costs and other associated factors. The findings suggest that discrete land use policy development is required to integrate non-TOD dissonant and TOD dissonant behaviours to support TOD development in Brisbane.

Uncovering the impact of organisational culture types on the willingness to share knowledge between projects

Current literature has established that organisational culture influences knowledge management efforts; however, it is only recently that research on project management has focused its interest on organisational culture in the context of knowledge sharing and some preliminary studies have been conducted. In response, this paper adds a significant contribution by providing rich empirical evidence of the relationships between culture and the willingness to share knowledge, demonstrating which cultural values are more and which are less likely to improve inter-project knowledge sharing behaviours. The use of interviews and the Organisational Culture Assessment Instrument (OCAI) (Cameron & Quinn, 2005) in the cross-case examination of culture in four participating cases has resulted in rich empirical contributions. Furthermore, this paper adds to the project management literature by introducing the Competing Values Framework (CVF) of Cameron and Quinn (2005) to evaluate knowledge sharing in the inter-project context.

Factors influencing caregiver : care receiver communication and its impact on the well-being of older care receivers

Examined communication between frail older people and their caregiving spouses (CGSs), and its relation to well-being in older care receivers. 53 community residing spousal dyads completed questionnaires about their well-being, relational satisfaction, and communication patterns. Conversations between the dyads were also videotaped and analyzed. The type of communication used by the CGSs was influenced by their sex, their earlier relationship with their spouse, and their level of well-being. CGSs who used an overly directive communication tone with their spouse were likely to be wives and CGSs who had a high degree of autonomy in their earlier relationship with their spouse. Low levels of life satisfaction and high affect balance in CGSs were associated with CGSs using a more patronizing tone. The well-being of care receivers was also related to their perceptions of their CGSs' communication. Care receivers who perceived their CGSs' communication as patronizing reported low levels of affect balance and high levels of conflict in the relationship. Findings suggest that certain characteristics of CGSs are related to the type of communication they use when conversing with their partner, although the relations are not always as expected.

Learning landscapes 2.0 : warning - assembly required

Twenty first century learners operate in organic, immersive environments. A pedagogy of student-centred learning is not a recipe for rooms. A contemporary learning environment is like a landscape that grows, morphs, and responds to the pressures of the context and micro-culture. There is no single adaptable solution, nor a suite of off-the-shelf answers; propositions must be customisable and infinitely variable. They must be indeterminate and changeable; based on the creation of learning places, not restrictive or constraining spaces. A sustainable solution will be un-fixed, responsive to the life cycle of the components and materials, able to be manipulated by the users; it will create and construct its own history. Learning occurs as formal education with situational knowledge structures, but also as informal learning, active learning, blended learning social learning, incidental learning, and unintended learning. These are not spatial concepts but socio-cultural patterns of discovery. Individual learning requirements must run free and need to be accommodated as the learner sees fit. The spatial solution must accommodate and enable a full array of learning situations. It is a system not an object. Three major components: 1. The determinate landscape: in-situ concrete 'plate' that is permanent. It predates the other components of the system and remains as a remnant/imprint/fossil after the other components of the system have been relocated. It is a functional learning landscape in its own right; enabling a variety of experiences and activities. 2. The indeterminate landscape: a kit of pre-fabricated 2-D panels assembled in a unique manner at each site to suit the client and context. Manufactured to the principles of design-for-disassembly. A symbiotic barnacle like system that attaches itself to the existing infrastructure through the determinate landscape which acts as a fast growth rhizome. A carapace of protective panels, infinitely variable to create enclosed, semi-enclosed, and open learning places. 3. The stations: pre-fabricated packages of highly-serviced space connected through the determinate landscape. Four main types of stations; wet-room learning centres, dry-room learning centres, ablutions, and low-impact building services. Entirely customised at the factory and delivered to site. The stations can be retro-fitted to suit a new context during relocation. Principles of design for disassembly: material principles • use recycled and recyclable materials • minimise the number of types of materials • no toxic materials • use lightweight materials • avoid secondary finishes • provide identification of material types component principles • minimise/standardise the number of types of components • use mechanical not chemical connections • design for use of common tools and equipment • provide easy access to all components • make component size to suite means of handling • provide built in means of handling • design to realistic tolerances • use a minimum number of connectors and a minimum number of types system principles • design for durability and repeated use • use prefabrication and mass production • provide spare components on site • sustain all assembly and material information