http://hdl.handle.net/10453/20443 2013-05-21T14:18:04Z http://hdl.handle.net/10453/21891 Clinical Stories shared at handover compared with formal documentation by Child and Family Health Nurses Kookarkin, Jane Louise The impetus for undertaking this study arises out of the author’s work as a Health Information Manager (HIM), employed within an Early Parenting Centre (EPC) with a predominant nursing workforce. To a HIM, quality documentation in the clinical record is of the utmost importance in ensuring that accurate clinical coding can be achieved with positive outcomes for clients, families and the organisation. The aim of this study is to investigate nursing documentation and handover practices within a child and family health (CFH) setting. The focus is on the differences between what nurses write in the clinical records and what they communicate verbally in ‘handover’. This study builds on the development of the ICD-10-AM Early Parenting Manual to examine the accuracy and quality of information collected in the clinical record. This study was conducted in three residential units of an EPC situated in Sydney, NSW. These EPC units provide early intervention for parents with young children through support and education. Nurses provide the majority of parenting intervention, support and education during a parent and child’s stay. A qualitative interpretive research approach was used employing several forms of data including case studies, interviews, field notes and questionnaires. The data analysis involved qualitative thematic content analysis in two parts; firstly the analysis of the transcripts of handover and the clinical record documentation through the use of a coding template; and secondly examination of the nursing interview transcripts using the themes identified from the verbal and written analysis. Demographic data collected from a nursing questionnaire and field notes were used to provide context to inform the analysis process and findings. This study identified a number of positive outcomes: comments from the nurses echoed their desire to learn and improve their documentation practices; the demographic data identified a wealth of nursing expertise and knowledge; and the changing nature of CFH nursing acknowledged that the RNs are now expected to work at a much higher level than in the past. Conversely, there were some concerns related to the barriers that impact on the nurses’ ability to accurately document their practice. They included confusion regarding who is the client, inconsistency of the parenting advice given, gaps in communication transfer of both written and verbal information, the changing and increasing educational needs of staff, the environment and the workload. It has clearly been identified that the area of CFH clinical information collection and clinical coding would benefit from more research. For the clinical coding process to be improved, more focused education for nurses is necessary to help them understand the need for quality documentation required by clinical coders. This stresses the importance of work place education and mentoring; and the importance of education about the role of clinical coding in undergraduate and post graduate nursing programs. Continuing professional development for nurses should include topics such as the importance of clinical documentation with regard to the introduction of Activity-Based Funding and the completion of clinical documentation using the eMR. Finally, further development should be undertaken in improving formal communication processes between all clinical staff. University of Technology, Sydney. Faculty of Health. 2012-01-01T00:00:00Z http://hdl.handle.net/10453/21871 The Effect of an algorithm based sedation guideline on the duration of mechanical ventilation for intensive care patients in an Australian intensive care unit Elliott, Rosalind Patients who are cared for in intensive care units (ICUs) have life threatening illnesses and require intrusive interventions and monitoring, which may cause discomfort. They often require analgesic medications to relieve pain and sedative medications to reduce anxiety. Agitation and accidental self-harm may result from providing too little medication and the administration of too much may lead to the prolongation of mechanical ventilation. Sedation guidelines offer the potential to reduce these problems. The aim of this study was to examine the effect of an algorithm based sedation guideline on the duration of mechanical ventilation of patients in an Australian ICU. Secondary aims included the effect of the guideline on the: patients’ perspective of their recovery; length of stay in ICU; number of tracheostomies; number of self-extubations and reintubations; and the cost of intravenous sedative medications. The rate of adoption of the guideline and sedation scale was examined. The intervention was tested in a quasi-experimental preintervention and postintervention study (n= 322). The sample comprised 58% men and the median age was 61.1 years (range 19.7 to 91.8 years). Mean Acute Physiology and Chronic Health Evaluation II score was 21.8 points (range 3 to 45 points). Nineteen percent of patients were admitted post operatively and 81% were admitted for non-operative medical diagnoses. Mechanical ventilation was instigated for 225 (70%) patients prior to admission to the study ICU. There was a 22% mortality rate. The groups were equivalent at baseline. The mean duration of mechanical ventilation was 4.33 days for the preintervention group and 5.64 days for the postintervention group (p=0.02). There was no difference in the patients’ perspective of their recovery. There was no difference in length of stay in ICU and the number of tracheostomies. The number of self-extubations and reintubations were similar. The overall cost of intravenous sedative medications increased slightly in the postintervention phase. Sedation scale adoption was poor in the preintervention phase but increased in the postintervention phase. The sedation guideline was gradually adopted in the postintervention phase. Adoption data suggests that patients were more deeply sedated during the postintervention phase. In conclusion, the sedation scale and sedation guideline were well adopted by the nurses. Patients were more deeply sedated when the guideline was used and there was a mean increase in duration of ventilation of 1.31 days. Other secondary patient outcomes were not affected. The successful implementation of a clinical guideline was demonstrated but was not associated with improvements in patient outcomes in this setting. 2005-01-01T00:00:00Z http://hdl.handle.net/10453/21860 Pricing Barrier Options under Scalar Diffusions using the Eigenfunction Expansion Approach Harahap, Mahrita Aisah In this thesis, we will present some methods used to price barrier options. We first price barrier options under the Black-Scholes model. Then we will discuss some of the shortcomings of the Black-Scholes model. Next we derive prices for barrier options under different classes of scalar diffusions. In particular, we will use eigenfunction expansions to price barrier options under the CEV model of price dynamics. 2010-01-01T00:00:00Z http://hdl.handle.net/10453/20420 mStories: Understanding the new literacies of mobile devices through a creative participatory project. Frawley, Jessica Traditional discussions on literacy have focused on the reading and writing of alphabet and character-based texts. However, innovations in information and communication technologies (ICT) have emphasised new forms of literacy that include still and moving image, and new modes of document reception and production. These ‘new’ literacies have become a significant area of research, however to date these understandings have been built without reference to the adult user, the informal learner and the mobile device. Though mobile devices enable increasingly multimodal behaviours little is known about how a device’s mobility affects these literacy practices. As Smartphone ownership increases and the semiotic landscape becomes increasingly multimodal there is a need for understandings of multiliteracies research to be applied and extended to the multimodal meaning-making afforded by mobile devices. In August 2011 mStories, a creative participatory action research project, was established by the researcher. Working with nine participants from Australia and the UK, mStories facilitates the creation and sharing of user generated stories created with mobile devices; in addition to changing user practice through action, this project contributes to understandings of multimodal mobile literacies through survey and interview research, and analysis of the mStories products. Grounded in the participant’s experiences and semiotic products, this thesis develops an understanding of literacy from the underrepresented adult user and the mobile technology that they use. From data derived from this participatory project, this thesis characterises mobile practice as one that is situated, locative, and experiential in nature; This project finds that mobile devices are catalytic to meaning-making within a wider ICT ecology. 2011-01-01T00:00:00Z