Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study

Objectives
This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients.

Design
Mixed-method multi-centre study.

Setting
High fidelity simulated acute clinical environment in three Australian universities.

Participants
A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study.

Method
In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance.

Results
Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p = .034), overall situation awareness (p = .05) and clinical performance in two of the three scenarios (p = .032 cardiac and p = .006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%.

Conclusions
Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.

The contribution of creativity to human development in a new nation: a case study of Afalyca community art centre, Timor-Leste

This article describes the contribution of creativity to human development in the new nation of Timor-Leste, exemplified in a case study of community art centre Afalyca. By taking a creative approach to the challenges of life in his developing country, the young leader of this enterprise, Marqy da Costa, is realising his own potential more fully and offering enriching experiences to others. The impact of his centre on a range of stakeholders, including staff, participants and the wider community is discussed. For participants, the outcomes of their involvement include enjoyable opportunities for creative expression; valued recognition from national and international audiences; the broadening of life experience to encompass new possibilities for self-actualisation; skill development and income from employment and sales.

The factors that have contributed to Afalcya's creative achievements are examined. These include inspiration and assistance received from organisations and individuals in and outside of Timor, family support, and the age and gender of leaders. Also significant are founder Marqy's personal characteristics of artistic talent, social and language skills, love of learning, persistence and conciliatory approach to conflict. Barriers to the realisation of Afalcya's potential include lack of systemic recognition of the value of creativity for sustainable development, unsupportive bureaucracy and gender related restrictions of participation for women. The potential for similar initiatives to contribute to a positive future for Timorese people is explored.

Submission to the New Zealand Parliamentary Inquiry : New Zealand Convention Centre Bill 2013

The Bill outlines the overarching purpose of the NZICC Agreement ‘to provide economic benefits to New Zealanders’. It is really a form of PPP (Public Private Partnership) where the beneficiaries are said to be the Crown and SkyCity but the real payment comes from the losses of the (mainly) community members who will gamble on the expanded facilities outlined in the Agreement. The Howeth International Convention and Exhibition Centre study (2009) established a clear business case for an international convention centre; with an optimistic benefit-cost ratio of 1.433 (which translates into a benefit to the economy of $1.433
for ever $1 spent). Aside from the short-term stimulus to jobs of the construction phase, a convention centre with capacity for 1000 delegates would create about 800 new jobs and attract up to 35 additional conferences of between 150 and 2500 delegates per year (an additional 22,000 additional international visitors and more than 200,000 extra visitor days, worth approximately $85.4 million in tourism-related expenditure per year15. It is therefore questionable as to why this venture needs to be captured by gambling interests, which will also dictate the location. This points to the efficacy of a non-casino provider being able to tender for establishment of an International Convention Centre that could be run profitably without being part of the for-profit model based on expanded gambling machines/revenue.

Comparing mortality outcomes of major burns and toxic epidermal necrolysis in a tertiary burns centre

 Introduction
Our aim was to provide descriptive information to burn clinicians, who have extensive experience treating major burns and determining prognosis, as to whether significant differences in mortality exist between major burns injuries and the comparatively less common toxic epidermal necrolysis for a given age and total body surface area percentage.

Methods
Retrospective data was analyzed of all deceased patients admitted to the Victorian Adult Burns Service in Melbourne, Australia over a period of 10 years with greater than 30% total body surface area burned or greater than 30% total body surface area epidermal detachment in the case of toxic epidermal necrolysis. Retrospective data was also collected on all patients, survivors and deceased, with toxic epidermal necrolysis and these patients were matched with burns patients by age and % total body surface area burned. Comparisons in outcomes were performed with mortality being the primary variable of interest.

Results
Toxic epidermal necrolysis patients that died were older (median: 68.5 vs 57 yrs; P = 0.04), had a longer length of hospital stay (36.5 vs 0.8 days; P = 0.001) and significantly longer periods of mechanical ventilation (1404 vs 14.5 h; P = 0.011) than major burns patients that died. When toxic epidermal necrolysis patients were matched to major burns patients by age and total body surface area burned, there were no significant differences between the two groups with respect to mortality.

Conclusion
Palliative care approaches are more frequently administered at the time of presentation for major burns patients in comparison to toxic epidermal necrolysis patients. This may be due to a perception that if toxic epidermal necrolysis patients can survive their initial systemic injury, they are likely to survive, as opposed to major burns patients who often undergo extensive surgery and for whom other factors should be taken into account in the context of end-of-life decision making.

Mortality and use of the auxiliary score in extensive toxic epidermal necrolysis patients admitted to an adult burns referral centre

 Background: Toxic epidermal necrolysis (TEN) is a rare but fatal condition characterised by cutaneous exfoliation of the dermoepidermal layer and mucosal surfaces. Extensive TEN with epidermal detachment >30% of the total body surface area has been associated with a high mortality. Objective: This study aims to evaluate factors associated with mortality in extensive TEN. In the absence of data to qualify scoring systems such as SCORTEN, this study also aims to evaluate the use of the auxiliary score as a tool for calculating expected mortality. Methods: A retrospective chart review of all patients presenting to our burns service with extensive TEN was undertaken. Application and evaluation of the auxiliary score was also undertaken for this patient population. Results: In extensive TEN, age and delay in admission to a burns centre were factors associated with mortality. Applying the auxiliary score to our patient population, there were no significant differences between expected mortality and observed mortality. Conclusion: Mortality was associated with age and delay in definitive treatment in extensive TEN. Whilst SCORTEN is the gold standard prognostic tool for patients with TEN, in the absence of SCORTEN values, the auxiliary score provides an alternative scoring system to evaluate expected mortality.

The Harbour outdoors: Investigating how children and educators engage with the outdoor learning space at the Harbour Family and Children's Centre

The aim of the research was to carry out an in-depth case study of the outdoor space at a purposively designed outdoor learning space in a demonstration childcare program in an Australian city. The design of the outdoor space emphasises natural elements and sustainability, while the program uses an indoor/outdoor approach with multi-age sharing of the space. The report included staff, management and researcher perspectives on how the outdoor space worked for children and staff, and provided findings that could inform the ongoing professional processes of reflection on the learning environment at the centre. In addition, the researchers also sought the views of the original designers of the outdoor space, and od centre management at the time when outdoor space was being designed and built. The researchers considered that their perspectives, along with those of current management and staff, could assist in addressing questions of long-term sustainability and practicality in the design of outdoor spaces in childcare centres.

Child physical activity levels and associations with modifiable characteristics in centre-based childcare

Objective: To describe children's physical activity levels during childcare and associations with modifiable characteristics. Methods: A cross-sectional study of 328 preschool children (43% girls; age 3-5 years) and 145 staff from 20 long day care centres in the Hunter Region of NSW, Australia. Pedometers assessed child physical activity levels. Centre characteristics and staff attitudes and behaviours towards children's physical activity were assessed using surveys, interviews and observational audit. Results were analysed using descriptive statistics and linear regression. Results: Over the measurement period, average step count of children was 15.8 (SD=6.8) steps/minute. Four-year-olds had the highest step counts (16.4, SD=7.1, p=0.03) with no differences by sex. Step counts were significantly higher in centres that had a written physical activity policy (+3.8 steps/minute, p=0.03) and where staff led structured physical activity (+3.7 steps/minute, p<0.001) and joined in active play (+2.9 steps/minute, p=0.06). Conclusions: Written physical activity policy, structured staff-led physical activity and staff joining in active play were associated with higher levels of physical activity. Implications: Childcare physical activity interventions should consider including strategies to encourage written physical activity policies and support structured staff led physical activities.