Medical error and decision making : learning from the past and present in intensive care

Background : Human error occurs in every occupation. Medical errors may result in a near miss or an actual injury to a patient that has nothing to do with the underlying medical condition. Intensive care has one of the highest incidences of medical error and patient injury in any specialty medical area; thought to be related to the rapidly changing patient status and complex diagnoses and treatments.

Purpose : The aims of this paper are to: (1) outline the definition, classifications and aetiology of medical error; (2) summarise key findings from the literature with a specific focus on errors arising from intensive care areas; and (3) conclude with an outline of approaches for analysing clinical information to determine adverse events and inform practice change in intensive care.

Data source : Database searches of articles and textbooks using keywords: medical error, patient safety, decision making and intensive care. Sociology and psychology literature cited therein.

Findings : Critically ill patients require numerous medications, multiple infusions and procedures. Although medical errors are often detected by clinicians at the bedside, organisational processes and systems may contribute to the problem. A systems approach is thought to provide greater insight into the contributory factors and potential solutions to avoid preventable adverse events.

Conclusion : It is recommended that a variety of clinical information and research techniques are used as a priority to prevent hospital acquired injuries and address patient safety concerns in intensive care.

What can Australia learn from the Europeans about public participation? Article 6 of the Aarhus Convention and environmental impact statements

The United Nations Economic Commission for Europe Convention on Access to Information, Public Participation in Decision-Making and Access to Justice in Environmental Matters (Aarhus Convention) is the only international convention that is exclusively devoted to public participation in environmental matters. Although it is European in origin, much of the detail of the Convention draws upon national environmental legislation, including aspects of the Australian environmental legal system. This article compares the public review provisions relating to environmental impact statements in Australia with Art 6 of the Convention governing "Public Participation in Decisions on Specific Activities". The article finds that much of the Australian laws with some exceptions satisfy the minimum requirements of public participation in Art 6.

A framework for re-thinking learning in science from recent cognitive science perspectives

Recent accounts by cognitive scientists of factors affecting cognition imply the need to reconsider current dominant conceptual theories about science learning. These new accounts emphasize the role of context, embodied practices and narrative-based representation rather than learners’ cognitive constructs. In this paper we analyze data from a longitudinal study of primary school children’s learning to outline a framework based on these contemporary accounts, and to delineate key points of difference from conceptual change perspectives. The findings suggest this framework provides strong theoretical and practical insights into how children learn and the key role of representational negotiation in this learning. We argue that the nature and process of conceptual change can be re-interpreted in terms of the development of students’ representational resources.

Social work and welfare education without discrimination : are we there yet?

The Australian Human Rights Commission (AHRC) has identified education as one of five crucial issues relating to the settlement of African Australians into the Australian community from a human rights perspective (AHRC 2009:5). In this paper I advocate that social work and welfare work in Australia are placed in important and multi dimensioned positions in relation to our complicities, responsibilities and potentialities with this educational human rights issue. As a Technical and Further Education (TAFE) welfare and University social work educator, I offer an outline of the ‘mutual respect inquiry approach’ that developed between myself and Southern Sudanese Australian students as a basis for discussion, reflection and change. I seek to stimulate thinking and action, particularly among those welfare work and social work educators, practitioners and students who identify as critical and anti-oppressive, to consider how these approaches can be realised and reshaped in practice to enhance not only Southern Sudanese Australians' right to education that is 'without discrimination', but indeed all students in our diversity.

Risk assessment with female sex offenders : can women meet the criteria of community protection laws?

Although females represent a small proportion of the sex offender population, they occasionally appear before the courts under the current generation of laws intended to protect the public from high-risk sex offenders. In this context, practitioners are called upon to provide assessment of the risk these women pose for sexual re-offending. The primary issues addressed in this paper are related to the validity of conducting such risk assessments and providing professional opinions as to the risk of further sexual offences that may be committed by female offenders. The approach taken is to summarize briefly the available professional literature regarding female sex offenders, and then to present the findings of the relatively few empirical studies that address sexual recidivism in females. The final section examines the positions taken in the published works of various international experts regarding risk assessment with females, followed by conclusions and recommendations in light of the standards typically prescribed by community protection laws.

Recent research (N=9,305) underscores the importance of using age-stratified actuarial tables in sex offender risk assessments

A useful understanding of the relationship between age, actuarial scores, and sexual recidivism can be obtained by comparing the entries in equivalent cells from “agestratified” actuarial tables. This article reports the compilation of the first multisample age-stratified table of sexual recidivism rates, referred to as the “multisample age-stratified table of sexual recidivism rates (MATS-1),” from recent research on Static-99 and another actuarial known as the Automated Sexual Recidivism Scale. The MATS-1 validates the “age invariance effect” that the risk of sexual recidivism declines with advancing age and shows that age-restricted tables underestimate risk for younger offenders and overestimate risk for older offenders. Based on data from more than 9,000 sex offenders, our conclusion is that evaluators should report recidivism estimates from age-stratified tables when they are assessing sexual recidivism risk, particularly when evaluating the aging sex offender.

An existential framework of spirituality

A holistic approach to spirituality indicates a spiritual development that is relevant for all students and not just for those who have a religious background. However, debates in England surrounding spirituality in education often generally locate it within the religious domain (Blake, 1996;Carr, 1995, 1999;Isherwood, 1999). Conceptualizing spirituality in such a way tends to deny access to this development for non-religious students or students in non-religious contexts. Alternatively the other approaches to spirituality have adopted non-religious viewpoints (see Erricker, 2003, p. 7). Such either/or approaches work against the notion that spirituality should be conceived as intrinsic to the enterprise of education. This paper offers a brief view of a more elaborate existential framework of spirituality which has been developed in order to transcend the religious/secular divide. A short account of Existentialist philosophy is provided before an outline of the framework is discussed.

The educative value of Dewey's religious attitude for spirituality

John Dewey's 'religious attitude' has great potential for the educative development of children's spirituality. This is because it enables their spiritual understandings to become more intelligently composed - not just in a cognitive or hyper-rational sense, but as a way of being. This paper provides an outline of Dewey's approach, which is described as being democratic, inquiry based, and 'scientific'. Such an approach therefore offers a contrast to other more epistemologically focused curricula which attempt to educate a person's spirituality. In order to make the case for the potential educative value of such an attitude, a brief review of Dewey's approach to education shall be offered, in which the notions of inquiry, democracy, and 'science' shall be highlighted to make the case that such attributes might be necessary for spiritual education if the United Nations Educational and Scientific Organization's goal of attaining world peace is to ever become possible.