Assessing performance in critical care nursing practice using the Benner Novice to expert model: A pilot study

Background It is often believed that by ensuring the ongoing completion of competency documents and life-long learning in nursing practice guarantees quality patient care. This is probably true in most cases where it provides reassurances that the nursing team is maintaining a safe “generalised” level of practice. However, competency does not always promise quality performance. There are a number of studies that have reported differences in what practitioners know and what they actually do despite being deemed competent. Aim The aim of this study was to assess whether our current competency documentation is fit for purpose and to ascertain whether performance assessment needs to be a key component in determining competence. Method 15 nurses within a General ICU who had been on the unit <4 years agreed to participate in this project. Using participant observation and assessing performance against key indicators of the Benner Novice to Expert5 model the participants were supported and assessed over the course of a ‘normal’ nursing shift. Results The results were surprising both positively and negatively. First, the nurses felt more empowered in their clinical decision making skills; second, it identified individual learning needs and milestones in educational development. There were some key challenges identified which included 5 nurses over estimating their level of competence, practice was still very much focused on task acquisition and skill and surprisingly some nurses still felt dominated by the other health professionals within the unit. Conclusion We found that the capacity and capabilities of our nursing workforce needs continual ongoing support especially if we want to move our staff from capable task-doer to competent performers. Using the key novice to expert indicators identified the way forward for us in how we assess performance and competence in practice particularly where promotion to higher grades is based on existing documentation.

Roy Kenzie Kiyooka

Roy Kenzie Kiyooka Canadian, born 1926 Roy Kiyooka was born in Moose Jaw, Saskatchewan in 1926. Throughout his career, he was known as a painter, photographer, sculptor, poet, musician, filmmaker and teacher. He studied at the Provincial Institute of Technology and Art in Calgary from 1946-49, and then at the Instituto Allende in Mexico in 1955. During the summers of 1958 - 1960 he attended the Emma Lake Workshops in Saskatchewan, where he worked closely with Barnett Newman and Clement Greenberg. In 1959 he executed his first series of abstract paintings, The Hoarfrost Series, which assume a disciplined minimal quality. In the late 1960's Kiyooka began to push beyond painting and created mixed media works, including collage, photography, film and poetry. Kiyooka’s art is born out of personal experience and through it he records his relationship to the surrounding landscape; a night in a motel, a trip to the coast, or hoarfrost on the trees. Through the unfolding of Kiyooka’s interior/exterior landscapes he shares his personal journeys with us all. The Art Gallery of Ontario's collection of Roy Kiyooka's work began with the purchase of two paintings; Barometer No. 2, in 1964 and Surya, in 1987.

Retoriset keinot ja kirjoittajaroolit virolaisen Postimees-lehden ja suomalaisen Helsingin Sanomien verkkosivujen mielipidekeskusteluissa

Työssä tutkitaan erilaisin tekstintutkimuksen keinoin suomalaisen Helsingin Sanomat -lehden ja virolaisen Postimees-lehden internet-julkaisuissa ilmestyneisiin uutisiin liittyviä mielipidekirjoituksia. Työn tavoitteena on tarkastella eroja suomalaisten ja virolaisten kirjoittajien retoriikassa, argumentaatiossa ja roolivalinnoissa. Työn aineisto koostuu Helsingin Sanomien ja Postimees´in internet-sivuilla tammikuussa 2008 ilmestyneiden uutisten saamista mielipiteistä eli kommenteista. Molemmista lehdistä on valittu mukaan kymmenen uutista, jotka kaikki ovat saaneet keskimäärin 30 kommenttia. Uutiset ovat molemmissa maissa kotimaan uutisia ja ne on valittu satunnaisesti, joskin muutamien uutisten aiheet ovat lehdissä samankaltaisia. Työn neljännessä luvussa aineistoa analysoidaan rekisterien, tekstityyppien ja retoriikan näkökulmista. Rekistereistä puhuttaessa tarkoitetaan erilaisia tapoja kirjoittaa erilaisissa tilanteissa. Internetistä löytyvät mielipidekirjoitukset vaihtelevat virallisen kirjakielen ja arkisen puhekielen, jopa slangin, käytön välillä. Mielipidekirjoitukset kuuluvat argumentoivaan tekstityyppiin. Niiden tehtävä ei ole kertoa asioista neutraalisti, vaan kirjoittaja ilmaisee tekstissään omia arvojaan, mielipiteitään ja käsityksiään. Viidennessä luvussa aineistoa tutkitaan retorisen diskurssianalyysin keinoin, eli analysoidaan millaisia retorisia keinoja kirjoittajat käyttävät argumentaationsa vahvistamiseen. Retorisia keinoja esitellään työssä Arja Jokisen esittämän jaotuksen mukaisesti. Argumentaatiota voidaan jaotella myös sen mukaan, onko kyseessä hyökkäävä, puolustava, fakta- tai tunnepohjainen retoriikka. Kuudennessa luvussa analysoidaan mielipidekirjoitusten kohteita eli adressaatteja sekä kirjoittajien itselleen ottamia rooleja. Kirjoittajat voivat osoittaa roolivalintaansa useiden retoristen keinojen avulla. Rooleista yleisimmät ovat opettaja, asiantuntija ja kriitikko, marginaalisempia puolestaan kysyjä ja kannattaja/tukija. Aineiston analysointi on nostanut esille useita eroja suomalaisten ja virolaisten mielipidekirjoitusten välillä. Suomalaiset kirjoitukset kirjoitetaan usein yleis- tai kirjakielellä ja neutraalilla sävyllä. Virolaisissa mielipidekirjoituksissa on enemmän puhekielisyyttä ja kirjoitusvirheitä. Kirjoitusten sävy on jyrkempi ja arvoja tai arvioita välittävät sanat usein hyvin affektisia. Suomalaisissa mielipidekirjoituksissa kirjoittajat käyttävät argumentaationsa vahvistamiseen paljon oman asiantuntijuutensa korostamista tai vahvistamista konsensuksella, oma pätevyys myös perustellaan koulutuksen tai ammatin avulla. Suomalaisissa kirjoituksissa mielipiteet ovat myös pääasiassa faktoihin ja puolustavaan retoriikkaan perustuvia. Virolaisissa mielipiteissä kirjoittajat esittävät väitteensä tosiasioina ilman erityisiä perusteita. Argumentaatio rakentuu pääasiallisesti hyökkäävän ja tunnepohjaisen retoriikan päälle. Myös roolivalintojen välillä on eroja: suomalaismielipiteet esitetään useimmiten opettajan tai asiantuntijan roolista, virolaisissa mielipiteissä kirjoittaja on yleensä kriitikko tai asiantuntija.

Evolution of cooperation by reciprocation within structured demes

The iterative two-person Prisoners’ Dilemma game has been generalised to theN-person case. The evolution of cooperation is explored by matching the Tit For Tat (TFT) strategy (Axelrod and Hamilton 1981) against the selfish strategy. Extension of TFT toN-person situations yields a graded set of strategies from the softest TFT, which continues cooperation even if only one of the opponents reciprocates it, to the hardest, which would do so only when all the remaining opponents cooperate. The hardest TFT can go to fixation against the selfish strategy provided it crosses a threshold frequencypc. All the other TFT are invadable by the selfish (D) or the pure defector strategy, while none can invadeD. Yet, provided a thresholdpc is crossed, they can coexist stably withD. AsN, the size of the group increases, the threshold pc also increases, indicating that the evolution of cooperation is more difficult for larger groups. Under certain conditions, only the soft TFT can coexist stably against the selfish strategyD, while the harder ones cannot. An interesting possibility of a complete takeover of the selfish population by successive invasions by harder and harder TFT strategies is also presented.

Depression and its assessment among stroke patients and their caregivers

Approximately one-third of stroke patients experience depression. Stroke also has a profound effect on the lives of caregivers of stroke survivors. However, depression in this latter population has received little attention. In this study the objectives were to determine which factors are associated with and can be used to predict depression at different points in time after stroke; to compare different depression assessment methods among stroke patients; and to determine the prevalence, course and associated factors of depression among the caregivers of stroke patients. A total of 100 consecutive hospital-admitted patients no older than 70 years of age were followed for 18 months after having their first ischaemic stroke. Depression was assessed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), Beck Depression Inventory (BDI), Hamilton Rating Scale (HRSD), Visual Analogue Mood Scale (VAMS), Clinical Global Impression (CGI) and caregiver ratings. Neurological assessments and a comprehensive neuropsychological test battery were performed. Depression in caregivers was assessed by BDI. Depressive symptoms had early onsets in most cases. Mild depressive symptoms were often persistent with little change during the 18-month follow-up, although there was an increase in major depression over the same time interval. Stroke severity was associated with depression especially from 6 to 12 months post-stroke. At the acute phase, older patients were at higher risk of depression, and a higher proportion of men were depressed at 18 months post-stroke. Of the various depression assessment methods, none stood clearly apart from the others. The feasibility of each did not differ greatly, but prevalence rates differed widely according to the different criteria. When compared against DSM-III-R criteria, sensitivity and specificity were acceptable for the CGI, BDI, and HRSD. The CGI and BDI had better sensitivity than the more specific HRSD. The VAMS seemed not to be a reliable method for assessing depression among stroke patients. The caregivers often rated patients depression as more severe than did the patients themselves. Moreover, their ratings seemed to be influenced by their own depression. Of the caregivers, 30-33% were depressed. At the acute phase, caregiver depression was associated with the severity of the stroke and the older age of the patient. The best predictor of caregiver depression at later follow-up was caregiver depression at the acute phase. The results suggest that depression should be assessed during the early post-stroke period and that the follow-up of those at risk of poor emotional outcome should be extended beyond the first year post-stroke. Further, the assessment of well-being of the caregivers of stroke patients should be included as a part of a rehabilitation plan for stroke patients.

The acceptability, usability and short-term outcomes of Get Real: A web-based program for psychotic-like experiences (PLEs)

Background Psychotic-like experiences (PLEs) are subclinical delusional ideas and perceptual disturbances that have been associated with a range of adverse mental health outcomes. This study reports a qualitative and quantitative analysis of the acceptability, usability and short term outcomes of Get Real, a web program for PLEs in young people. Methods Participants were twelve respondents to an online survey, who reported at least one PLE in the previous 3 months, and were currently distressed. Ratings of the program were collected after participants trialled it for a month. Individual semi-structured interviews then elicited qualitative feedback, which was analyzed using Consensual Qualitative Research (CQR) methodology. PLEs and distress were reassessed at 3 months post-baseline. Results User ratings supported the program's acceptability, usability and perceived utility. Significant reductions in the number, frequency and severity of PLE-related distress were found at 3 months follow-up. The CQR analysis identified four qualitative domains: initial and current understandings of PLEs, responses to the program, and context of its use. Initial understanding involved emotional reactions, avoidance or minimization, limited coping skills and non-psychotic attributions. After using the program, participants saw PLEs as normal and common, had greater self-awareness and understanding of stress, and reported increased capacity to cope and accept experiences. Positive responses to the program focused on its normalization of PLEs, usefulness of its strategies, self-monitoring of mood, and information putting PLEs into perspective. Some respondents wanted more specific and individualized information, thought the program would be more useful for other audiences, or doubted its effectiveness. The program was mostly used in low-stress situations. Conclusions The current study provided initial support for the acceptability, utility and positive short-term outcomes of Get Real. The program now requires efficacy testing in randomized controlled trials.

Vibrations of a Beam in Variable Contact With a Flat Surface

We study small vibrations of cantilever beams contacting a rigid surface. We study two cases: the first is a beam that sags onto the ground due to gravity, and the second is a beam that sticks to the ground through reversible adhesion. In both cases, the noncontacting length varies dynamically. We first obtain the governing equations and boundary conditions, including a transversality condition involving an end moment, using Hamilton's principle. Rescaling the variable length to a constant value, we obtain partial differential equations with time varying coefficients, which, upon linearization, give the natural frequencies of vibration. The natural frequencies for the first case (gravity without adhesion) match that of a clamped-clamped beam of the same nominal length; frequencies for the second case, however, show no such match. We develop simple, if atypical, single degree of freedom approximations for the first modes of these two systems, which provide insights into the role of the static deflection profile, as well as the end moment condition, in determining the first natural frequencies of these systems. Finally, we consider small transverse sinusoidal forcing of the first case and find that the governing equation contains both parametric and external forcing terms. For forcing at resonance, w find that either the internal or the external forcing may dominate.

Guests at Sophie Oppenheimer's 70th birthday celebration Portraits Groups

Handwritten on verso: (top l-r) Heinz Marcus, Hilde Marcus, Heinz Ascher, Else Stern, Gerhard Ascher, Hattie Wallerstein, Kurt Stern, Paula Stern, Lula Ascher and Hilde Marcus; (second row l-r) Otto Oppenheimer, Heinrich Ascher, Julius Stern, David Wallerstein, Max Marcus, Alex Goldschmidt and Ernst Oppenheimer; (third row l-r) Rose, Hans Oppenheimer, Gertrud Ascher, Oma Oppenheimer, Emma, Martha, Lene, Lucy, Hans, Lore; (front row l-r) Margot Ascher, Heinz Ascher, Golda Ascher, Edith Goldschmidt, Irma Ascher, Lotti Goldschmidt, Gretl Oppenheimer and Ilse Oppenheimer

Preliminary investigation into development of forage budget application and device

Forage budgeting, land condition monitoring and maintaining ground cover residuals are critical management practices for the long term sustainability of the northern grazing industry. The aim of this project is to do a preliminary investigation into industry need, feasibility and willingness to adopt a simple to use hand-held hardware device and compatible, integrated software applications that can be used in the paddock by producers, to assist in land condition monitoring and forage budgeting for better Grazing Land Management and to assist with compliance.

Leading Sheep II

Leading Sheep is an education framework for leading the adoption of new technologies and practices to increase the productivity of the Queensland sheep industry.

Leading Sheep III

Leading Sheep is a framework for supporting decision-making about technologies and practices to increase the profitability and productivity of the Queensland Sheep Businesses. Leading Sheep aims to achieve a high level of engagement with sheep businesses in Queensland to support their ongoing decision making processes about productivity and profitability.

Making More from Sheep Phase II : MMfS State Coordination – Queensland

Making More from Sheep (MMfS) is a majority market extension program funded by Meat & Livestock Australia (MLA) and Australian Wool Innovation (AWI). Phase II of MMfS commenced in Queensland with a business planning process in October 2010 and delivery from November 2010 until November 2013. Mr Tony Hamilton of the Department of Agriculture, Fisheries and Forestry (DAFF) was initially the State Coordinator with responsibility for planning, project implementation, monitoring and evaluation. He was replaced by Ms Nicole Sallur from DAFF towards the end of the project. Delivery involving partner organisations provided best practice management information and tools to sheep producers with target Key Performance Indicators (KPI’s) exceeded across all three tiers of engagement category. 31 events were delivered to 551 participants. Satisfaction and value scores averaged across all events measured 8.7 and 8.2 respectively. Operational recommendations have been included in the report.

Demonstrating recovery of pasture productivity, Mulga Lands - Bollon, South West Queensland

Pasture recovery PDS, Mulga lands.

A mega-analysis of genome-wide association studies for major depressive disorder

Prior genome-wide association studies (GWAS) of major depressive disorder (MDD) have met with limited success. We sought to increase statistical power to detect disease loci by conducting a GWAS mega-analysis for MDD. In the MDD discovery phase, we analyzed more than 1.2 million autosomal and X chromosome single-nucleotide polymorphisms (SNPs) in 18 759 independent and unrelated subjects of recent European ancestry (9240 MDD cases and 9519 controls). In the MDD replication phase, we evaluated 554 SNPs in independent samples (6783 MDD cases and 50 695 controls). We also conducted a cross-disorder meta-analysis using 819 autosomal SNPs with P<0.0001 for either MDD or the Psychiatric GWAS Consortium bipolar disorder (BIP) mega-analysis (9238 MDD cases/8039 controls and 6998 BIP cases/7775 controls). No SNPs achieved genome-wide significance in the MDD discovery phase, the MDD replication phase or in pre-planned secondary analyses (by sex, recurrent MDD, recurrent early-onset MDD, age of onset, pre-pubertal onset MDD or typical-like MDD from a latent class analyses of the MDD criteria). In the MDD-bipolar cross-disorder analysis, 15 SNPs exceeded genome-wide significance (P<5 x 10(-8)), and all were in a 248 kb interval of high LD on 3p21.1 (chr3:52 425 083-53 822 102, minimum P=5.9 x 10(-9) at rs2535629). Although this is the largest genome-wide analysis of MDD yet conducted, its high prevalence means that the sample is still underpowered to detect genetic effects typical for complex traits. Therefore, we were unable to identify robust and replicable findings. We discuss what this means for genetic research for MDD. The 3p21.1 MDD-BIP finding should be interpreted with caution as the most significant SNP did not replicate in MDD samples, and genotyping in independent samples will be needed to resolve its status.

Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs

Most psychiatric disorders are moderately to highly heritable. The degree to which genetic variation is unique to individual disorders or shared across disorders is unclear. To examine shared genetic etiology, we use genome-wide genotype data from the Psychiatric Genomics Consortium (PGC) for cases and controls in schizophrenia, bipolar disorder, major depressive disorder, autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD). We apply univariate and bivariate methods for the estimation of genetic variation within and covariation between disorders. SNPs explained 17-29% of the variance in liability. The genetic correlation calculated using common SNPs was high between schizophrenia and bipolar disorder (0.68 +/- 0.04 s.e.), moderate between schizophrenia and major depressive disorder (0.43 +/- 0.06 s.e.), bipolar disorder and major depressive disorder (0.47 +/- 0.06 s.e.), and ADHD and major depressive disorder (0.32 +/- 0.07 s.e.), low between schizophrenia and ASD (0.16 +/- 0.06 s.e.) and non-significant for other pairs of disorders as well as between psychiatric disorders and the negative control of Crohn's disease. This empirical evidence of shared genetic etiology for psychiatric disorders can inform nosology and encourages the investigation of common pathophysiologies for related disorders.