Ca Mather

Management of Type 2 diabetes in Western Australian metropolitan general practice

The purpose of this study was: (1) to record GP opinions, practices and outcomes for the care of Type 2 Diabetes Mellitus (DM2), (2) compare practice facilities and process of care with a criterion of recommended competent care and (3) determine if there were any differences between vocationally registered and non-vocationally registered GPs. A random sample of 204 metropolitan doctors from 124 practices was selected and an audit performed on 467 of their patient records. GPs pursued good blood sugar control and advocated lifestyle changes before hypoglycaemic drugs. Over 80% regard uncomplicated DM2 as a condition for general practice management. However, only 15% conducted an annual diabetes check, 9% had a diabetic register, 6% a diabetic recall system and 8% used a diabetic health care checklist for monitoring their patients. The most commonly recorded processes of medical audit in the previous 12 months were: blood pressure (94%), duration of diabetes (72%), blood glucose (70%), diet (66%), body weight (56%), HBA1c (52%) and ophthalmoscopy (50%). The least commonly recorded processes of care were body mass index (5%), inspection of the feet (18%), enquiries about vaginitis or impotence (23%). The amount of exercise, alcohol and tobacco was recorded in only 34% of records. Hypoglycaemic drugs were used appropriately but the most commonly used drugs for treating hypertension in DM2 patients were thiazide diuretics and beta-blockers. Vocationally registered (VR) doctors had better records, higher process of care scores and more were willing to participate in the study than non-vocationally registered (NVR) doctors. However, there was no difference in metabolic control between patients from either group. The use of a Diabetic Health Care Checklist would improve diabetes care especially in the search for early complications and in the recording of HBA1c and other metabolic parameters. The drugs commonly used to control hypertension can have adverse effects on glucose and lipid metabolism and should be replaced with glucose and lipid neutral drugs.

Nurses’ Use of Mobile Devices to Access Information in Health Care Environments in Australia: A Survey of Undergraduate Students

Background The growth of digital technology has created challenges for safe and appropriate use of mobile or portable devices during work-integrated learning (WIL) in health care environments. Personal and professional use of technology has outpaced the development of policy or codes of practice for guiding its use at the workplace. There is a perceived risk that portable devices may distract from provision of patient or client care if used by health professionals or students during employment or WIL. Objective This study aimed to identify differences in behavior of undergraduate nurses in accessing information, using a portable or mobile device, when undertaking WIL compared to other non-work situations. Methods A validated online survey was administered to students while on placement in a range of health care settings in two Australian states. Results There were 84 respondents, with 56% (n=47) reporting access to a mobile or portable device. Differences in use of a mobile device away from, compared with during WIL, were observed for non-work related activities such as messaging (P<.001), social networking (P<.001), shopping on the Internet (P=.01), conducting personal business online (P=.01), and checking or sending non-work related texts or emails to co-workers (P=.04). Study-related activities were conducted more regularly away from the workplace and included accessing University sites for information (P=.03) and checking or sending study-related text messages or emails to friends or co-workers (P=.01). Students continued to access nursing, medical, professional development, and study-related information away from the workplace. Conclusions Undergraduate nurses limit their access to non-work or non-patient centered information while undertaking WIL. Work-related mobile learning is being undertaken, in situ, by the next generation of nurses who expect easy access to mobile or portable devices at the workplace, to ensure safe and competent care is delivered to their patients.

Audio teleconferencing: creative use of a forgotten innovation.

As part of a regional School of Nursing and Midwifery’s commitment to addressing recruitment and retention issues, approximately 90% of second year undergraduate student nurses undertake clinical placements at: multipurpose centres; regional or district hospitals; aged care; or community centres based in rural and remote regions within the State. The remaining 10% undertake professional experience placement in urban areas only. This placement of a large cohort of students, in low numbers in a variety of clinical settings, initiated the need to provide consistent support to both students and staff at these facilities. Subsequently the development of an audio teleconferencing model of clinical facilitation to guide student teaching and learning and to provide support to registered nurse preceptors in clinical practice was developed. This paper draws on Weimer’s ‘Personal Accounts of Change’ approach to describe, discuss and evaluate the modifications that have occurred since the inception of this audio teleconferencing model (Weimer, 2006).

Governing mobile technology use for continuing professional development in the Australian nursing profession

BackgroundThe rapid growth in the use of mobile technology in Australia has outpaced its governance, especially in healthcare settings. Whilst some Australian professional bodies and organisations have developed standards and guidelines to direct appropriate use of social media and mobile technology, clear governance arrangements regarding when, where and how to use mobile technology at point of care in nursing are currently lacking.DiscussionThis paper analyses how the use of mobile technology by nurses at point of care is governed. It highlights the existence of a mobile technology paradox: an identified inability of nurses to access mobile technology in a context where it is increasingly recognised that its use in situ can enhance nursing practice while contributing to mobile learning and continuing professional development. While the recent release of the Registered Nurse Standards for Practice and accompanying Standard for Continuing Professional Development provides some direction regarding professional standards to support the use of mobile technology for mobile learning, we argue a more inclusive approach is required if emerging technologies are to be fully embraced. We describe how an implementation framework, underpinned by more detailed standards, guidelines and codes, could enable the nursing profession to be leaders in embedding mobile technology in healthcare environments nationally and globally.ConclusionThe prevalence of mobile technology in Australia has outpaced its governance in healthcare environments. Its limited availability at point of care is hindering nursing practice, mobile learning and continuing professional development. We discuss the emergence of mobile technology and impediments for its use by nurses in situ. We analyse the professional codes governing nursing, outlining potential reforms to enable implementation of mobile technology at point of care by nurses.

Review: The evaluation of a home-based paediatric nursing service: concept and design development using The Kirkpatrick Model

The authors of the reviewed paper have chosen to use Kirkpatrick’s model (2016) as the structure for evaluation of this programme. This is laudable; however, for all application of models of evaluation, it needs to be clear why this choice was made, and that the implementation of the evaluation is in fidelity with the model. In this instance, the authors have chosen to use the upgraded ‘New World’ Kirkpatrick model (2016). For the purposes of this review, an analysis of the application of the ‘new world’ Kirkpatrick model by Jones et al., 2018 is presented, so that others can judge the fulfilment of the new model’s potential. Many scholars will be aware of the original Kirkpatrick’s model (1996) being widely used to evaluate education programmes for health professionals. However, as Jones et al. indicate, it has been criticised in the literature for lack of acknowledgement of the difficulties associated with evaluating behaviour (level 3) and reporting results (level 4). The development of the modified Kirkpatrick model has led the authors to describe the model further (Kirkpatrick and Kirkpatrick, 2007) and then develop the ‘New World’ Kirkpatrick model (Kirkpatrick and Kirkpatrick, 2016). The new model has clarified the importance of level 3 by acknowledging that behaviour change is the culmination of a range of factors including learning and experiences. Training may lead to changes in practice or

Review: Development and validation of the taste alteration scale for children receiving chemotherapy

Bilsin and Bal Yılmaz (2018) have spent considerable time and effort in developing and trialling an instrument that can measure alteration in taste in children with cancer. The science behind this process is well established (Bernstein, 1978; Davies and Tuleu, 2008; Harris, 2008). The authors of the reviewed study have rigorously demonstrated its validity and reliability; however, the claim that Cronbach’s alpha is a measure of reliability should remain a contested space (Sijtsma, 2009). Development of this instrument raises the question of clinical validity. While the concept of clinical validity tends to lack the same scientific rigour as psychometric measures used to develop assessment instruments, it is very important to acknowledge its legitimacy in terms of utility and credibility for its use with practising paediatric oncology nurses (Garcia et al., 2016). The advancement of medication regimens for the treatment of childhood cancer, the mitotic index, and the stomatoxicity of some medications, does not protect treated children from developing painful mouths (Sung et al., 2017). Children undergoing treatment for cancer, especially young children, have little capacity to resist what happens to them, except when it involves the oral cavity (Walco et al., 2005). When the mouth is sore and painful a child may decide ‘there’s no way I am eating or taking that’. During treatment there is competition for access to the mouth, whether for medications or for nutrition, and while both are important, it tends to be medications that take precedence. An instrument to assess alteration in taste is challenging to use in the context of clinical practice. A ‘before’ treatment assessment probably needs to be made, so that changes in taste are evident by assessment ‘after’ treatment. However, this type of assessment is unlikely to be

Clinical Simulation: A Protocol for Evaluation of Mobile Technology

For mobile technology to be accepted at point of care in healthcare environments there is a need to demonstrate benefits whilst ameliorating the risks and challenges. To provide a standardised approach to evaluation of mobile technology a simulation protocol was developed to provide guidance for its use in healthcare environments. Simulated conditions provide the opportunity to assess intended and unintended consequences and identify potential workarounds when using technology. The protocol can also be used to demonstrate the importance of the development of digital professionalism by end-users prior to students entering the clinical practice setting. The mobile technology protocol was adapted from a health information systems protocol developed and used at the ITX Lab, Denmark for use in other simulation laboratories. Use case scenarios were developed to enable evaluation of mobile technology for mobile learning of nurses, nurse supervisors, students and patients. The scenarios can be used in a range of simulated environments including hospital bedside, outpatient clinic or community settings. A case study exemplar of a nurse and patient is included to demonstrate how the mobile technology protocol can be applied.

Helping Hands : Using Augmented Reality to Provide Remote Guidance to Health Professionals

Access to expert practitioners or geographic distance can compound the capacity for appropriate supervision of health professionals in the workplace. Guidance and support of clinicians and students to undertake new or infrequent procedures can be resource intensive. The Helping Hands remote augmented reality system is an innovation to support the development of, and oversee the acquisition of procedural skills through remote learning and teaching supervision while in clinical practice. Helping Hands is a wearable, portable, hands-free, low cost system comprised of two networked laptops, a head-mounted display worn by the recipient and a display screen used remotely by the instructor. Hand hygiene was used as the test procedure as it is a foundation skill learned by all health profession students. The technology supports unmediated remote gesture guidance by augmenting the object with the Helping Hands of a health professional. A laboratory-based study and field trial tested usability and feasibility of the remote guidance system. The study found the Helping Hands system did not compromise learning outcomes. This innovation has the potential to transform remote learning and teaching supervision by enabling health professionals and students opportunities to develop and improve their procedural performance at the workplace.

Identifying Opportunities to Integrate Digital Professionalism into Curriculum: A Comparison of Social Media Use by Health Profession Students at an Australian University in 2013 and 2016

Social media has become ubiquitous to modern life. Consequently, embedding digital professionalism into undergraduate health profession courses is now imperative and augmenting learning and teaching with mobile technology and social media on and off campus is a current curriculum focus. The aim of this study was to explore whether patterns of social media use for personal or informal learning by undergraduate health profession students enrolled at an Australian university across four campuses has changed over time. A previously validated online survey was administered in 2013 to a cohort of health profession students as part of an Australian survey. In 2016, the same survey was distributed to a later cohort of health profession students. Three open-ended questions to elicit descriptive information regarding the use of social media for study purposes were added to the later survey. A comparative analysis of both cohorts was undertaken and social media acceptance and penetration was shown to increase. Health profession students are now more interactive users of Facebook and Twitter, and they have become more familiar with career development sites, such as LinkedIn. The maturation of social media platforms within a three-year period has created realistic opportunities to integrate social media for personal and study purposes into the health profession education curriculum to ensure student understanding of the necessity for maintaining digital professionalism in the workplace.

Advancing Social Media and Mobile Technologies in Healthcare Education

Social media and mobile technologies are important new tools in healthcare education, both to assist healthcare professionals learn and maintain their craft, and for the education of patients and families [...]