Creating a therapeutic environment : a non-randomised controlled trial of a quiet time intervention for patients in acute care

Background: Noise is a significant barrier to sleep for acute care hospital patients, and sleep has been shown to be therapeutic for health, healing and recovery. Scheduled quiet time interventions to promote inpatient rest and sleep have been successfully trialled in critical care but not in acute care settings. Objectives: The study aim was to evaluate as cheduled quiet time intervention in an acute care setting. The study measured the effect of a scheduled quiet time on noise levels, inpatients’ rest and sleep behaviour, and wellbeing. The study also examined the impact of the intervention on patients’, visitors’ and health professionals’ satisfaction, and organisational functioning. Design: The study was a multi-centred non-randomised parallel group trial. Settings: The research was conducted in the acute orthopaedic wards of two major urban public hospitals in Brisbane, Australia. Participants: All patientsadmitted to the two wards in the5-month period of the study were invited to participate, withafinalsample of 299 participants recruited. This sample produced an effect size of 0.89 for an increase in the number of patients asleep during the quiet time. Methods: Demographic data were collected to enable comparison between groups. Data for noise level, sleep status, sleepiness and well being were collected using previously validated instruments: a Castle Model 824 digital sound level indicator; a three point sleep status scale; the Epworth Sleepiness Scale; and the SF12 V2 questionnaire. The staff, patient and visitor surveys on the experimental ward were adapted from published instruments. Results: Significant differences were found between the two groups in mean decibel level and numbers of patients awake and asleep. The difference in mean measured noise levels between the two environments corresponded to a ‘perceived’ difference of 2 to 1. There were significant correlations between average decibel level and number of patients awake and asleep in the experimental group, and between average decibel level and number of patients awake in the control group. Overall, patients, visitors and health professionals were satisfied with the quiet time intervention. Conclusions: The findings show that a quiet time intervention on an acute care hospital ward can affect noise level and patient sleep/wake patterns during the intervention period. The overall strongly positive response from surveys suggests that scheduled quiet time would be a positively perceived intervention with therapeutic benefit.

The Second Life of urban planning? Using neogeography tools for community engagement

The majority of the world’s citizens now live in cities. Although urban planning can thus be thought of as a field with significant ramifications on the human condition, many practitioners feel that it has reached the crossroads in thought leadership between traditional practice and a new, more participatory and open approach. Conventional ways to engage people in participatory planning exercises are limited in reach and scope. At the same time, socio-cultural trends and technology innovation offer opportunities to re-think the status quo in urban planning. Neogeography introduces tools and services that allow non-geographers to use advanced geographical information systems. Similarly, is there potential for the emergence of a neo-planning paradigm in which urban planning is carried out through active civic engagement aided by Web 2.0 and new media technologies thus redefining the role of practicing planners? This paper traces a number of evolving links between urban planning, neogeography and information and communication technology. Two significant trends – participation and visualisation – with direct implications for urban planning are discussed. Combining advanced participation and visualisation features, the popular virtual reality environment Second Life is then introduced as a test bed to explore a planning workshop and an integrated software event framework to assist narrative generation. We discuss an approach to harness and analyse narratives using virtual reality logging to make transparent how users understand and interpret proposed urban designs.

A qualitative analysis of local community communications

This paper explores how people communicate in reference to local interests and suggests information and communication technology (ICT) design for enhancement of local community networks. Qualitative data was gathered from participant observations of local community collective action and open interviews with active community members. Data analysis revealed concepts, leading to categories in relation to local interactions and interests. Design suggestions consider introducing people to local community private-strategic activity via public displays that indicate simple entry points to active participation, and creating information collections according to local community perspectives for long-term reference.

A collaborative digestion and design game for community and technology exploration

In this paper, we present interim results from the Communities and Place project, which is exploring methods for understanding communities in a variety of contexts, and how to inform the design of technology to support them. We report on our experience with adapting an existing game-based approach for working with video as a resource in participatory design processes. Our adaptations allow the approach to be used with diverse data arising out of the different communities we are engaged with, and different design traditions we approach the problem from, leading to the formation of common design themes to inform our future work on this project.

Research Monograph: Building Online Participatory Systems: Towards the Community Based Interactive Environmental Decision Support Systems

The importance of broadening community participation in environmental decision-making is widely recognized and lack of participation in this process appears to be a perennial problem. In this context, there have been calls from some academics for the more extensive use of geographic information systems (GIS) and distance learning technologies, accessible via the Internet, as a possible means to inform and empower communities. However, a number of problems exist. For instance, at present the scope for online interaction between policy-makers and citizens is currently limited. Contemporary web-based environmental information systems suffer from this lack of interactivity on the one hand and on the other hand from the apparent complexity for the lay user. This paper explores the issue of online community participation at the local level and attempts to construct a framework for a new (and potentially more effective) model of online participatory decision-making. The key components, system architecture and stages of such a model are introduced. This model, referred to as a ‘Community Based Interactive Environmental Decision Support System’, incorporates advanced information technologies, distance learning and community involvement tools which will be applied and evaluated in the field through a pilot project in Tokyo in the summer of 2002.

Research Monograph: The role of community and lifestyle in the making of a knowledge city

Our brief is to investigate the role of community and lifestyle in the making of a globally successful knowledge city region. Our approach is essentially pragmatic. We start by broadly examining knowledge-based urban development from a number of different perspectives. The first view is historical. In this context knowledge work and knowledge workers are seen as vital parts of a new emergent mode of production reliant on the continual production of abstract knowledge. We briefly develop this perspective to encompass the work of Richard Florida who has, notedly, claimed: “Wherever talent goes, innovation, creativity, and economic growth are sure to follow.” Our next perspective examines concepts of knowledge and modes of its production to discover knowledge is not an unchanging object but a human activity that changes in form and content through history. The suggestion emerges that not only is the production of contemporary ‘knowledge’ organised in a specific (and new) manner but also the output of this networked production is a particular type of knowledge (i.e. techné). The third perspective locates knowledge production and its workers in the contemporary urban context. As such, it co-ordinates the knowledge city in the increasingly global structure of cities and develops a typology of different groups of knowledge workers in their preferred urban environment(s). We see emerging here a distinctive geography of knowledge production. It is an urban phenomenon. There is, in short, something about the nature of cities that knowledge workers find particularly attractive. In the next, essentially anthropological, perspective we start to explore the needs and desires of the individual knowledge worker. Beyond the needs basic to any modern human household an attempt is made to deduce, from a base understanding of knowledge work as mental labour, the compensatory cultural needs of the knowledge worker when not at work - and the expression of these needs in the urban fabric. Our final perspective consists of two case studies. In a review of the experiences of Austin, Texas and Singapore’s one-north precinct we collect empirical data on, respectively, a knowledge city that has sustained itself for over 50 years and an urban precinct newly launched into the global market for knowledge work and knowledge workers. Interwoven The Role of Community and Lifestyle in the Making of a Knowledge City Urban Research Program 8 through all perspectives, in the form of apposite citation, is that of ‘expert opinion’ gathered in a rudimentary poll of academic and industry sources. This opinion appears in text boxes while details of the survey can be found in Appendix A. In the conclusion of the report we interpret the wide range of evidence gathered above in a policy frame. It is our hope this report will leave the reader with a clearer picture of the decisive organisational, infrastructural, aesthetic and social dimensions of a knowledge precinct.

Exploring non-cancer pain conditions in a community sample : critiquing a current conceptual model of the acute to chronic pain transition and examining predictors of chronicity

This program of research examines the experience of chronic pain in a community sample. While, it is clear that like patient samples, chronic pain in non-patient samples is also associated with psychological distress and physical disability, the experience of pain across the total spectrum of pain conditions (including acute and episodic pain conditions) and during the early course of chronic pain is less clear. Information about these aspects of the pain experience is important because effective early intervention for chronic pain relies on identification of people who are likely to progress to chronicity post-injury. A conceptual model of the transition from acute to chronic pain was proposed by Gatchel (1991a). In brief, Gatchel’s model describes three stages that individuals who have a serious pain experience move through, each with worsening psychological dysfunction and physical disability. The aims of this program of research were to describe the experience of pain in a community sample in order to obtain pain-specific data on the problem of pain in Queensland, and to explore the usefulness of Gatchel’s Model in a non-clinical sample. Additionally, five risk factors and six protective factors were proposed as possible extensions to Gatchel’s Model. To address these aims, a prospective longitudinal mixed-method research design was used. Quantitative data was collected in Phase 1 via a comprehensive postal questionnaire. Phase 2 consisted of a follow-up questionnaire 3 months post-baseline. Phase 3 consisted of semi-structured interviews with a subset of the original sample 12 months post follow-up, which used qualitative data to provide a further in-depth examination of the experience and process of chronic pain from respondents’ point of view. The results indicate chronic pain is associated with high levels of anxiety and depressive symptoms. However, the levels of disability reported by this Queensland sample were generally lower than those reported by clinical samples and consistent with disability data reported in a New South Wales population-based study. With regard to the second aim of this program of research, while some elements of the pain experience of this sample were consistent with that described by Gatchel’s Model, overall the model was not a good fit with the experience of this non-clinical sample. The findings indicate that passive coping strategies (minimising activity), catastrophising, self efficacy, optimism, social support, active strategies (use of distraction) and the belief that emotions affect pain may be important to consider in understanding the processes that underlie the transition to and continuation of chronic pain.

Enriching relationships : community engagment toward sustainable coastal futures

Coastal communities face the social, cultural and environmental challenges of managing rapid urban and industrial development, expanding tourism, and sensitive ecological environments. Enriching relationships between communities and universities through a structured engagement process can deliver integrated options towards sustainable coastal futures. This process draws on the embedded knowledge and values of all participants in the relationship, and offers a wide and affordable range of options for the future. This paper reviews lessons learnt from two projects with coastal communities, and discusses their application in a third. Queensland University of Technology has formed collaborative partnerships with industry in Queensland's Wide Bay-Burnett region to undertake a series of planning and design projects with community engagement as a central process. Senior students worked with community and produced design and planning drawings and reports outlining future options for project areas. A reflective approach has been adopted by the authors to assess the engagement process and outcomes of each project to learn lessons to apply in the next. Methods include surveying community and student participants regarding the value they place on process and outcomes respectively in planning for a sustainable future. All project participants surveyed have placed high importance on the process of engagement, emphasising the value of developing relationships between all project partners. The quality of these relationships is central to planning for sustainable futures, and while the outcomes the students deliver are valued, it is as much for their catalytic role as for their contents. Design and planning projects through community engagement have been found to develop innovative responses to the challenges faced by coastal communities seeking direction toward sustainable futures. The enrichment of engagement relationships and processes has an important influence on the quality of these design and planning responses.

Empowerment games : empathic design probes for user participation in community housing

This paper documents the empowering process of a group of public housing residents through different design probing exercises. These exercises worked along with existing social processes without any involvement of designers. This paper shows how a design researcher devised a series of probing tools called "empowerment games" with a group of active users. These games are self-learning tools for making the abstract language of design legible to users. The main purpose of this intitiative was to change the preconception of govenmental bodies and professional designers of the passivity of the users with regard to their designed environment. This was the first case of the application of a participatory design process in Hong Kong subsidized housing. Design empathy is a central skill when working with users throughout the whole design research project.

Stem cell technologies : regulation, patents and problems

Human embryonic stem cell research promises to deliver in the future a whole range of therapeutic treatments, but currently governments in different jurisdictions must try to regulate this burgeoning area. Part of the problem has been, and continues to be, polarised community opinion on the use of human embryonic stem cells for research. This article compares the approaches of the Australian, United Kingdom and United States governments in regulating human embryonic stem cell research. To date, these governments have approached the issue through implementing legislation or policy to control research. Similarly, the three jurisdictions have viewed the patentability of human embryonic stem cell technologies in their own ways with different policies being adopted by the three patent offices. This article examines these different approaches and discusses the inevitable concerns that have been raised due to the lack of a universal approach in relation to the regulation of research; the patenting of stem cell technologies; and the effects patents granted are having on further human embryonic stem cell research.

Understanding rural and remote schools, and facilitating school-community relationships

Rural and remote schools make up a significant portion of Australian schools. Although there are rural schools that exceed 500 students, the Australian Bureau of Statistics (ABS) (2008) reports that 2,188 Australian primary schools have enrolment numbers less than 100. Rural schools need a supply of good teachers; however many universities involved in teacher education are located in city areas. For example, Queensland University of Technology is city-based, generating the highest number of early career teachers for Queensland including teachers for rural schools. Given the number of graduates and the number of rural schools, it seems likely that early career teachers will have opportunities for teaching in these settings, which also means living within a rural community. This chapter will discuss the nature of teaching in rural and remote schools, the challenges, the rewards and the importance of working closely with the local community. It is hoped that by understanding rural and remote schools, early career teachers can make informed decisions that will influence their future career prospects.