Tactics for teaching evidence-based practice : improving self-efficacy in finding and appraising evidence in a master's evidence-based practice unit

Universal application of evidence-based practice (EBP) is far from a reality with many clinicians feeling ill equipped to adopt this approach in their clinical practice (Melnyk Fineout- Overholt, Feinstein, Sadler, & Green-Hernandez, 2008; Sherriff, Wallis, & Chaboyer, 2007) and, thus, to be an intelligent consumer of evidence (Ciliska, 2005). While recognizing the benefit of EBP, many health professionals have low confidence in their skills for using evidence in clinical settings (Nagy, Lumby, McKinley, &Macfarlane, 2001). Educational initiatives are often recommended for promoting adoption of EBP with much of the focus being on providing knowledge of associated processes. Levin, Melnyk, Fineout-Overholt, Barnes, and Vetter (2011) demonstrated that providing knowledge of EBP process alone does not increase clinicians’ confidence in their ability to apply EBP to their practice...

Mapping geographical knowledge and skills needed for pre-service teachers in teacher education

In Australia, for more than two decades, a ‘social science’ integrated framework was the favoured approach for delivering subjects such as history and geography. However, such interdisciplinary approaches have continued to attract criticism from various parts of the academic and public spheres and since 2009, a return to teaching the disciplines has been heralded as the ‘new’ way forward. Using discourse analysis techniques associated with Foucauldian archaeology, the purpose of this paper is to examine the Australian Curriculum: Geography document to ascertain the discourses necessary for pre-service teachers to enact effective teaching of geography in a primary setting. Then, based on pre-service teachers’ online survey responses, the paper investigates if such future teachers have the knowledge and skills to interpret, deliver and enact the new geography curriculum in primary classrooms. Finally, as teacher educators, our interest lies in preparing pre-service teachers effectively for the classroom so the findings are used to inform the content of a teacher education course for pre-service primary teachers.

Considerations for a social and geographical framework for agent-based epidemics

Understanding the dynamics of disease spread is of crucial importance, in contexts such as estimating load on medical services to risk assessment and intervention policies against large-scale epidemic outbreaks. However, most of the information is available after the spread itself, and preemptive assessment is far from trivial. Here, we investigate the use of agent-based simulations to model such outbreaks in a stylised urban environment. For most diseases, infection of a new individual may occur from casual contact in crowds as well as from repeated interactions with social partners such as work colleagues or family members. Our model therefore accounts for these two phenomena.Presented in this paper is the initial framework for such a model, detailing implementation of geographical features and generation of social structures. Preliminary results are a promising step towards large-scale simulations and evaluation of potential intervention policies.

Geographical information systems for dengue surveillance

This review provides details on the role of Geographical Information Systems (GIS) in current dengue surveillance systems and focuses on the application of open access GIS technology to emphasize its importance in developing countries, where the dengue burden is greatest. It also advocates for increased international collaboration in transboundary disease surveillance to confront the emerging global challenge of dengue.

Affordances of ICTs: an environmental study of a French language unit offered at university level

This project investigates the integration of Information Communication Technologies (ICTs) into educational settings by closely looking at the uptake of the perceived affordances offered by ICTs by students enrolled in a French language course at Queensland University of Technology. This cross-disciplinary research uses the theoretical concepts of: Ecological Psychology (Gibson, 1979; Good, 2007; Reed, 1996); Ecological Linguistics (Greeno, 1994; Leather & van Dam, 2003; van Lier 2000, 2003, 2004a, 2004b); Design (Norman, 1988, 1999); Software Design/ Human-Computer Interaction (Hartson, 2003; McGrenere & Ho, 2000); Learning Design (Conole & Dyke, 2004a, 2004b; Laurillard et al. 2000;); Education (Kirschner, 2002; Salomon, 1993; Wijekumar et al., 2006) and Educational Psychology (Greeno, 1994). In order to investigate this subject, the following research questions, rooted in the theoretical foundations of the thesis, were formulated: (1) What are the learners’ attitudes towards the ICT tools used in the project?; (2) What are the affordances offered by ICTs used in a specific French language course at university level from the perspective of the teacher and from the perspective of language learners?; (3) What affordances offered by ICT tools used by the teacher within the specific teaching and learning environment have been taken up by learners?; and (4) What factors influence the uptake by learners of the affordances created by ICT tools used by the teacher within the specific teaching and learning environment? The teaching phase of this project, conducted between 2006 and 2008, used Action Research procedures (Hopkins, 2002; McNiff & Whitehead, 2002; van Lier 1994) as a research framework. The data were collected using the following combination of qualitative and quantitative methods: (1) questionnaires administered to students (Hopkins, 2002; McNiff & Whitehead, 2002) using Likert-scale questions, open questions, yes/no questions; (2) partnership classroom observations of research participants conducted by Research Participant Advocates (Hopkins, 2002; McNiff & Whitehead, 2002); and (3) a focus group with volunteering students who participated in the unit (semi-structured interview) (Hopkins, 2002; McNiff & Whitehead, 2002). The data analysis confirms the importance of a careful examination of the teaching and learning environment and reveals differences in the ways in which the opportunities for an action offered by the ICTs were perceived by teacher and students, which impacted on the uptake of affordances. The author applied the model of affordance, as described by Good (2007), to explain these differences and to investigate their consequences. In conclusion, the teacher-researcher considers that the discrepancies in perceiving the affordances result from the disparities between the frames of reference and the functional contexts of the teacher-researcher and students. Based on the results of the data analysis, a series of recommendations is formulated supporting calls for careful analysis of frames of reference and the functional contexts of all participants in the learning and teaching process. The author also suggests a modified model of affordance, outlining the important characteristics of its constituents.

Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: A prospective cohort study

The purpose of this study was to identify pressure ulcer (PU) incidence and risk factors that are associated with PU development in patients in two adult intensive care units (ICU) in Saudi Arabia. A prospective cohort study design was used. A total of 84 participants were screened second daily basis until discharge or death, over a consecutive 30-day period, out of which 33 participants with new PUs were identified giving a cumulative hospital-acquired PU incidence of 39·3% (33/84 participants). The incidence of medical devices-related PUs was 8·3% (7/84). Age, length of stay in the ICU, history of cardiovascular disease and kidney disease, infrequent repositioning, time of operation, emergency admission, mechanical ventilation and lower Braden Scale scores independently predicted the development of a PU. According to binary logistic regression analyses, age, longer stay in ICU and infrequent repositioning were significant predictors of all stages of PUs, while the length of stay in the ICU and infrequent repositioning were associated with the development of stages II-IV PUs. In conclusion, PU incidence rate was higher than that reported in other international studies. This indicates that urgent attention is required for PU prevention strategies in this setting.

Pilot study evaluating the effect of massage therapy on stress, anxiety and aggression in a young adult psychiatric inpatient unit

Objective: The aim of the present pilot study was to examine the effectiveness of a relaxation massage therapy programme in reducing stress, anxiety and aggression on a young adult psychiatric inpatient unit. Method: This was a prospective, non-randomized intervention study comparing treatment as usual (TAU) with TAU plus massage therapy intervention (MT) over consecutive 7 week blocks (May–August 2006). MT consisted of a 20 min massage therapy session offered daily to patients during their period of hospitalization. The Kennedy Nurses’ Observational Scale for Inpatient Evaluation (NOSIE), the Symptom Checklist-90–Revised (SCL-90-R), the State–Trait Anxiety Inventory (STAI) and stress hormone (saliva cortisol) levels were used to measure patient outcomes at admission and discharge from the unit. The Staff Observation Aggression Scale–Revised (SOAS-R) was used to monitor the frequency and severity of aggressive incidents on the unit. Results: There was a significant reduction in self-reported anxiety (p < 0.001), resting heart rate (p < 0.05) and cortisol levels (p < 0.05) immediately following the initial and final massage therapy sessions. Significant improvements in hostility (p = 0.007) and depression scores (p < 0.001) on the SCL-90-R were observed in both treatment groups. There was no group×time interaction on any of the measures. Poor reliability of staff-reported incidents on the SOAS-R limited the validity of results in this domain. Conclusions: Massage therapy had immediate beneficial effects on anxiety-related measures and may be a useful de-escalating tool for reducing stress and anxiety in acutely hospitalized psychiatric patients. Study limitations preclude any definite conclusions on the effect of massage therapy on aggressive incidents in an acute psychiatric setting. Randomized controlled trials are warranted.

Engaging nursing students in a bioscience unit using a web-based response system, GoSoapBox

Nursing students used GoSoapBox, a web-based student response system to poll responses to multiple choice questions (MCQs) presented during bioscience lectures. Participation in GoSoapBox appears to have facilitated student engagement, interaction and learning. The majority of students surveyed appreciated the immediate feedback to the student responses and being able to participate anonymously. The use of this tool facilitated collaborative group and class discussion and clarification around any misconceptions or challenging concepts. Information collected using GoSoapBox provided the academic with feedback allowing for reflection, adjustment and improvement in framing of formative and summative MCQs.

Facebook: A basis for forming a peer learning community for nursing students in a bioscience unit

First year nursing students commonly find bioscience to be challenging. A Facebook community site was established to support and engage these students. The site was facilitated by virtual peer mentors and the unit coordinator. The high participation rate and the strong recommendation to future students indicated that the site successfully enabled student interaction and engagement with their learning. The students found it to be a readily accessible network and valued the useful resources and learning strategies provided by their peers. The sharing of both learning challenges and successful learning practices can help students build a sense of belonging and an understanding of academic practices and behaviours that can contribute to their learning success at university.

Engaging nursing students in a bioscience unit using a web-based response system, GoSoapBox

Nursing students used GoSoapBox, a web-based student response system to poll responses to multiple choice questions (MCQs) presented during bioscience lectures. Participation in GoSoapBox appears to have facilitated student engagement, interaction and learning. The majority of students surveyed appreciated the immediate feedback to the student responses and being able to participate anonymously. The use of this tool facilitated collaborative group and class discussion and clarification around any misconceptions or challenging concepts. Information collected using GoSoapBox provided the academic with feedback allowing for reflection, adjustment and improvement in framing of formative and summative MCQs.

Have you got what it takes? Nursing in a Psychiatric Intensive Care Unit

Purpose A Psychiatric Intensive Care Unit (PICU) and or High Dependency Unit (HDU) is a locked, intensive treatment facility available to people experiencing acute psychiatric distress. For many people who access public mental health services in Australia, the PICU/HDU is the primary point of admission, and should represent and facilitate timely assessment and an optimum treatment plan under a recovery framework. Nurses are the largest health discipline working in this specialty area of care. The paper aims to discuss these issues. Design/methodology/approach A qualitative study aimed to investigate the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. Identifying how nurses provide care in the PICU/HDU will inform a clinical practice guideline to further support this specialty area of care. Four focus groups were facilitated with 52 registered nurses attending. Findings The nurse participants identified specific skills under four distinct themes; Storytelling, Treatment and recovery, Taking responsibility, and Safeguarding. The skills highlight the expertise and clinical standard required to support a recovery model of care in the PICU. Research limitations/implications – The research findings highlight urgency for a National PICU/HDU clinical practice guideline. Practical implications A PICU/HDU practice guideline will promote the standard of nursing care required in the PICU/HDU. The PICU/HDU needs to be recognised as a patient centred, therapeutic opportunity as opposed to a restrictive and custodial clinical area. Social implications Providing transparency of practice in the PICU/HDU and educating nurses to this specialty area of care will improve client outcome and recovery. Originality/value Very few studies have explored the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. A dearth of research exists on what is required to work in this specialty area of care.

Impact of a stroke unit on length of hospital stay and in-hospital case fatality

Background and Purpose Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward. Methods A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index. Results Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30% (P<0.0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5% with stroke unit care. Conclusions We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.

The grapes of wrath: The Coonawarra dispute, geographical indications and international trade

The famous wine region of Coonawarra in South Australia has been promoted as ’Australia's other Red Centre', emphasizing its terra rossa soil and its cabernet sauvignon. In his atlas of the wine regions of Australia, John Beeston comments upon the rich and contested history of the region: ’Coonawarra is certainly the most famous cabernet sauvignon region in Australia, and some would argue, the most renowned wine region in Australia per se'. A reporter, Penelope Debelle, captures a sense of the legal conflict over the parameters of the boundaries of Coonawarra: ’Behind the name Coonawarra, an inglorious contest is being waged that pits the romance of South Australia's terra rossa cool-climate wine region against the cold commercial reality of the label.'This Chapter tells the story behind the Coonawarra litigation, addressing the parties to the dispute; the legal and historical context of the case; and the immediate impact case, as well as its lingering significance. It considers the ’Coonawarra' case as, very literally, a landmark in Australian jurisprudence in respect of intellectual property. This chapter engages in the methodology of ’legal storytelling'. In the field of new historicism, the use of anecdotes - petite histoire - has been seen as a useful way of challenging grand historical narratives. Joel Fineman has observed that the anecdote is ’the literary form or genre that uniquely refers to the real.' This chapter has three parts. Part 1 outlines the European Community - Australia Wine Agreement 1994, and the operation of the Australian Wine and Brandy Corporation Act 1980 (Cth). Part 2 considers the various stages of the dispute over the Coonawarra region - moving from the decision of the Geographical Indications Committee, to the ruling of the Administrative Appeals Tribunal; and the conclusive decision of the Full Court of the Federal Court of Australia. Part 3 examines the implications of the Coonawarra litigation for other wine regions of Australia - most notably, the King Valley in Victoria; but also the Hunter Valley in the New South Wales; and the Margaret River in Western Australia. The conclusion considers the ramifications of the European Community-Australia Wine Agreement 2007, which has been initialed by both sides.

Virtual countries: Internet domain names and geographical terms

This paper examines the dispute between the Seattle company Virtual Countries Inc. and the Republic of South Africa over the ownership of the domain name address southafrica.com. The first part of the paper deals with the pre-emptive litigation taken by Virtual Countries Inc. in a District Court of the United States. The second part considers the possible arbitration of the dispute under the Uniform Domain Name Dispute Resolution Process of the Internet Corporation for Assigned Names and Numbers (ICANN) and examines the wider implications of this dispute for the jurisdiction and the governance of ICANN. The final section of the paper evaluates the Final Report of the Second WIPO Internet Domain Name Process.

Pre-service teachers’ perceptions of authentic learning in a capstone unit

Capstone units in higher education courses are learning experiences which are designed to bring reflection and focus to a whole course of study while, at the same time, leading students toward their entry into a new world of work (Humphrey, Brown, & Benson, 2005). The capstone experience described in this paper runs as a conference, called the Stepping Out Conference. The conference is delivered as one unit and is mandatory for all fourth year pre-service teachers. Participation in a capstone unit is an effective way for students to begin thinking of themselves as teaching professionals rather than as continuing students. Students engage in the assessment as part of their capstone experience. The assessment is designed to measure students’ knowledge and skills as they relate to ‘authentic’ real life situations (Darling-Hammond, 1991). This paper details pre-service teachers’ experiences of authentic learning through their participation in a capstone unit.