Testing the effectiveness of a Practice Development intervention on changing the culture of evidence based practice in an acute care environment

In this age of evidence-based practice, nurses are increasingly expected to use research evidence in a systematic and judicious way when making decisions about patient care practices. Clinicians recognise the role of research when it provides valid, realistic answers in practical situations. Nonetheless, research is still perceived by some nurses as external to practice and implementing research findings into practice is often difficult. Since its conceptual platform in the 1960s, the emergence and growth of Nursing Development Units, and later, Practice Development Units has been described in the literature as strategic, organisational vehicles for changing the way nurses think about nursing by promoting and supporting a culture of inquiry and research-based practice. Thus, some scholars argue that practice development is situated in the gap between research and practice. Since the 1990s, the discourse has shifted from the structure and outcomes of developing practice to the process of developing practice, using a Practice Development methodology; underpinned by critical social science theory, as a vehicle for changing the culture and context of care. The nursing and practice development literature is dominated by descriptive reports of local practice development activity, typically focusing on reflection on processes or outcomes of processes, and describing perceived benefits. However, despite the volume of published literature, there is little published empirical research in the Australian or international context on the effectiveness of Practice Development as a methodology for changing the culture and context of care - leaving a gap in the literature. The aim of this study was to develop, implement and evaluate the effectiveness of a Practice Development model for clinical practice review and change on changing the culture and context of care for nurses working in an acute care setting. A longitudinal, pre-test/post-test, non-equivalent control group design was used to answer the following research questions: 1. Is there a relationship between nurses' perceptions of the culture and context of care and nurses' perceptions of research and evidence-based practice? 2. Is there a relationship between engagement in a facilitated process of Practice Development and change in nurses' perceptions of the culture and context of care? 3. Is there a relationship between engagement in a facilitated process of Practice Development and change in nurses' perceptions of research and evidence-based practice? Through a critical analysis of the literature and synthesis of the findings of past evaluations of Nursing and Practice Development structures and processes, this research has identified key attributes consistent throughout the chronological and theoretical development of Nursing and Practice Development that exemplify a culture and context of care that is conducive to creating a culture of inquiry and evidence-based practice. The study findings were then used in the development, validation and testing of an instrument to measure change in the culture and context of care. Furthermore, this research has also provided empirical evidence of the relationship of the key attributes to each other and to barriers to research and evidence-based practice. The research also provides empirical evidence regarding the effectiveness of a Practice Development methodology in changing the culture and context of care. This research is noteworthy in its contribution to advancing the discipline of nursing by providing evidence of the degree to which attributes of the culture and context of care, namely autonomy and control, workplace empowerment and constructive team dynamics, can be connected to engagement with research and evidence-based practice.

An analysis of the effectiveness of parliamentary questions in the Uttar Pradesh State Legislative Assembly (India)

Parliamentary questions are the most popular and visible tool for making the executive accountable to the legislature. However, their use, purpose and effectiveness vary in different countries. In this study, 4023 parliamentary questions asked in the Uttar Pradesh State Legislative Assembly were analysed. The results show that half of the total members of the Assembly used this device. Contrary to findings in the Australian parliamentary system, there was no evidence of ‘Dorothy Dix’ and party influence on parliamentary questions. Furthermore, 30% of the questions were aimed at seeking information and 70% pressed for action. The government provided the required information in 95% of the questions in the former category but only took action in 37% in the latter category. The study concludes that parliamentary questions serve as an effective legislative tool in the Uttar Pradesh Legislature

The promoting adult resilience (PAR) program : the effectiveness of the second, shorter pilot of a workplace prevention program

This article details the second, successful pilot of the Promoting Adult Resilience (PAR) program in the human-services departments of a local government organization. The PAR program is a strengths-based resilience building program that integrates Interpersonal and CBT perspectives and this pilot use a shorter, 7-week version of the program. Pre, post and follow-up measures on PAR participants from a resource-sector company were compared with a non-intervention matched comparison group. Post-test, PAR participants reported greater self-efficacy, more family satisfaction, greater f\work-life fit and balance and less negative family to work spillover than the comparison group. At the 6-month follow-up, these gains were maintained to a lesser degree, although work-life balance was strengthened, and negative spillover in both directions reduced. Participants also reported greater optimism for the future, greater work satisfaction and promisingly for human service workers, exhaustion was reduced and more vigour, important for human services as burnout, exhaustion is part of this is a serious work hazard

Social support and fires in the workplace : a preliminary investigation

Workers who experience fire in the workplace are faced with disruption to their work routine, as well as the emotional strain of the fire. In the broader occupational stress literature, researchers have suggested that social support will be most effective at reducing the negative effects of stressors on strain when the type of support matches the type of stressor being experienced (either instrumental or emotional). This study was a preliminary investigation into employee responses to less routine stressors, such as workplace fires, and the role of different sources of social support in predicting coping effectiveness. This study also was a first attempt at considering the influence of the social context (in terms of group identification) on the effectiveness of social support as a predictor of coping effectiveness. Specifically, it was predicted that social support would be more effective when it came from multiple sources within the organization, that it would be especially effective when provided from a group that workers identified more strongly with, and that simply feeling part of a group would improve adjustment. Both quantitative and qualitative data were collected from 33 employees who had recently experienced a significant fire in their workplace. Results suggested that the type of stressors experienced and the type of support were mismatched, but despite this, coping effectiveness was generally moderate to high. There was mixed support for predictions about the effects of social support–no moderating effect of group identification on coping effectiveness was observed for measures of workplace support, although it did moderate the effects of family support on this adjustment indicator.

Security of employee entitlements : corporate governance issues

Following the collapse across the last decade of a number of large organizations such as Enron in the USA and several domestic organizations including Ansett Airlines, HIH Insurance and One.Tel, much discussion has ensued about the need to secure employee entitlements. However, tangible improvements in this area are elusive. Good corporate governance policies would suggest that deferred obligations as well as current debts should not be neglected and that appropriate arrangements be put in place to adequately fund employee entitlements. In this paper we consider recent Australian attempts to introduce better governance of employee entitlements.

Effectiveness of community-based nonpharmacological interventions for early-stage dementia : conclusions and recommendations

In 2007, a comprehensive review of the extant research on nonpharmacological interventions for persons with early-stage dementia was conducted. More than 150 research reports, centered on six major domains, were included: early-stage support groups, cognitive training and enhancement programs, exercise programs, exemplar programs, health promotion programs, and “other” programs not fitting into previous categories. Theories of neural regeneration and plasticity were most often used to support the tested interventions. Recommendations for practice, research, and health policy are outlined, including evidence-based, nonpharmacological treatment protocols for persons with mild cognitive impairment and early-stage dementia. A tested, community-based, multimodal treatment program is also described. Overall, findings identify well-supported nonpharmacological treatments for persons with early-stage dementia and implications for a national health care agenda to optimize outcomes for this growing population of older adults.

The cost effectiveness of Naltrexone added to cognitive-behavioral therapy in the treatment of alcohol dependence

he purpose of this study was to evaluate the comparative cost of treating alcohol dependence with either cognitive behavioral therapy (CBT) alone or CBT combined with naltrexone (CBT+naltrexone). Two hundred ninety-eight outpatients dependent on alcohol who were consecutively treated for alcohol dependence participated in this study. One hundred seven (36%) patients received adjunctive pharmacotherapy (CBT+naltrexone). The Drug Abuse Treatment Cost Analysis Program was used to estimate treatment costs. Adjunctive pharmacotherapy (CBT+naltrexone) introduced an additional treatment cost and was 54% more expensive than CBT alone. When treatment abstinence rates (36.1% CBT; 62.6% CBT+naltrexone) were applied to cost effectiveness ratios, CBT+naltrexone demonstrated an advantage over CBT alone. There were no differences between groups on a preference-based health measure (SF-6D). In this treatment center, to achieve 100 abstainers over a 12-week program, 280 patients require CBT compared with 160 CBT+naltrexone. The dominant choice was CBT+naltrexone based on modest economic advantages and significant efficiencies in the numbers needed to treat.

On the cognitive effectiveness of routing symbols in process modeling languages

Process models provide visual support for analyzing and improving complex organizational processes. In this paper, we discuss differences of process modeling languages using cognitive effectiveness considerations, to make statements about the ease of use and quality of user experience. Aspects of cognitive effectiveness are of importance for learning a modeling language, creating models, and understanding models. We identify the criteria representational clarity, perceptual discriminability, perceptual immediacy, visual expressiveness, and graphic parsimony to compare and assess the cognitive effectiveness of different modeling languages. We apply these criteria in an analysis of the routing elements of UML Activity Diagrams, YAWL, BPMN, and EPCs, to uncover their relative strengths and weaknesses from a quality of user experience perspective. We draw conclusions that are relevant to the usability of these languages in business process modeling projects.

The effectiveness of marketing communication within the immersive environment

Immersive environments are part of a recent media innovation that allow users to become so involved within a computer-based simulated environment that they feel part of that virtual world (Grigorovici, 2003). A specific example is Second Life, which is an internet-based, three-dimensional immersive virtual world in which users create an online representation of themselves (an avatar) to play games and interact socially with thousands of people simultaneously. This study focuses on Second Life as an example of an immersive environment, as it is the largest adult freeform virtual world, home to 12 million avatars (IOWA State University, 2008). Already in Second Life there are more than 100 real-life brands from a range of industries, including automotive, professional services, and consumer goods and travel, among others (KZero, 2007; New Business Horizons, 2009). Compared to traditional advertising media, this interactive media can immerse users in the environment. As a result of this interactivity, users can become more involved with a virtual environment, resulting in prolonged usage over weeks, months and even years. Also, it can facilitate presence. Despite these developments, little is known about the effectiveness of marketing messages in a virtual world context. Marketers are incorporating products into Second Life using a strategy of online product placement. This study, therefore, explores the perceived effectiveness of online product placement in Second Life in terms of effects on product/brand recall, purchase intentions and trial. This research examines the association between individuals’ involvement with Second Life and online product placement effectiveness, as well as the relationship between individuals’ Second Life involvement and the effectiveness of online product placement. In addition, it investigates the association of immersion and product placement involvement. It also examines the impact of product placement involvement on online product placement effectiveness and the role of presence in affecting this relationship. An exploratory study was conducted for this research using semi-structured in-depth interviews face-to-face, email-based and in-world. The sample comprised 24 active Second Life users. Results indicate that product placement effectiveness is not directly associated with Second Life involvement, but rather effectiveness is impacted through the effect of Second Life involvement on product placement involvement. A positive relationship was found between individuals’ product placement involvement and online product placement effectiveness. Findings also indicate that online product placement effectiveness is not directly associated with immersion. Rather, it appears that effectiveness is impacted through the effect of immersion on product placement involvement. Moreover, higher levels of presence appear to have a positive impact on the relationship between product placement involvement and product placement effectiveness. Finally, a model was developed from this qualitative study for future testing. In terms of theoretical contributions, this study provides a new model for testing the effectiveness of product placement within immersive environments. From a methodological perspective, in-world interviews as a new research method were undertaken. In terms of a practical contribution, findings identified useful information for marketers and advertising agencies that aim to promote their products in immersive virtual environments like Second Life.

Service employee behaviour : the role of compliance and risk taking

This paper looks at the decision-making process that determines the amount of effort frontline service employees will expend in delivering a service in a business-to-business context. Using theories in behavioural economics and interactional and social psychology, the paper develops and presents a model of employee decision-making. Managerial implications, which have the potential to enhance the marketing of business-to-business services and directions for future research in this area, are indicated.

Assessing the effectiveness of water sensitive urban design in Southeast Queensland

Water Sensitive Urban Design (WSUD) systems have the potential mitigate the hydrologic disturbance and water quality concerns associated with stormwater runoff from urban development. In the last few years WSUD has been strongly promoted in South East Queensland (SEQ) and new developments are now required to use WSUD systems to manage stormwater runoff. However, there has been limited field evaluation of WSUD systems in SEQ and consequently knowledge of their effectiveness in the field, under storm events, is limited. The objective of this research project was to assess the effectiveness of WSUD systems installed in a residential development, under real storm events. To achieve this objective, a constructed wetland, bioretention swale and a bioretention basin were evaluated for their ability to improve the hydrologic and water quality characteristics of stormwater runoff from urban development. The monitoring focused on storm events, with sophisticated event monitoring stations measuring the inflow and outflow from WSUD systems. Data analysis undertaken confirmed that the constructed wetland, bioretention basin and bioretention swale improved the hydrologic characteristics by reducing peak flow. The bioretention systems, particularly the bioretention basin also reduced the runoff volume and frequency of flow, meeting key objectives of current urban stormwater management. The pollutant loads were reduced by the WSUD systems to above or just below the regional guidelines, showing significant reductions to TSS (70-85%), TN (40-50%) and TP (50%). The load reduction of NOx and PO4 3- by the bioretention basin was poor (<20%), whilst the constructed wetland effectively reduced the load of these pollutants in the outflow by approximately 90%. The primary reason for the load reduction in the wetland was due to a reduction in concentration in the outflow, showing efficient treatment of stormwater by the system. In contrast, the concentration of key pollutants exiting the bioretention basin were higher than the inflow. However, as the volume of stormwater exiting the bioretention basin was significantly lower than the inflow, a load reduction was still achieved. Calibrated MUSIC modelling showed that the bioretention basin, and in particular, the constructed wetland were undersized, with 34% and 62% of stormwater bypassing the treatment zones in the devices. Over the long term, a large proportion of runoff would not receive treatment, considerably reducing the effectiveness of the WSUD systems.

Virtual product placement as a new approach to measure effectiveness of placements

Product placement is a fast growing multi-billion dollar industry yet measures of its effectiveness, which influence the critical area of pricing, have been problematic. Past attempts to measure the effect of a placement, and therefore provide a basis for pricing of placements, have been confounded by the effect on consumers of multiple prior exposures of a brand name in all marketing communications. Virtual product placement offers certain advantages: as a tool to measure the effectiveness of product placements; assistance with the problem of lack of audience selectivity in traditional product placement; testing different audiences for brands and addressing a gap in the existing academic literature by focusing on the impact of product placement on recall and recognition of new brands.