The role of course development and design in an itinerant schooling program: the perceptions of staff members of the School of Distance Education in Brisbane, Queensland

This paper examines the perceptions of teachers associated with the Brisbane School of Distance Education (Queensland, Australia), concerning their role in the establishment and implementation of a primary education program for children of the Showmen's Guild of Australasia. Interviews with five itinerant teachers revealed that their responsibilities include assessing correspondence papers from students and maintaining telephone contact with students, home tutors, and parents, as well as working in selected towns on a short-term basis to teach 'face-to-face' lessons to itinerant students. Each teacher worked with between 15 and 20 children, usually in family groups across grade levels. Teachers expressed concerns about the show children's lifestyle and how this has affected their educational and social development. However, all teachers felt that the distance education program had improved the children's educational opportunities and adequately addressed their educational needs. Disadvantages of the children's itinerant lifestyle that the program was unable to address were lack of routine, lack of continuity, dependence on the support of the home tutor, role conflicts of local teachers, and insufficient program funding. Implications for other itinerant education projects include recognizing the importance of teacher attitudes when implementing an educational program for a marginalized group. Contains 20 references. (LP

Medical interns' reflections on their training in use of personal protective equipment.

BACKGROUND:The current COVID-19 pandemic has demonstrated that personal protective equipment (PPE) is essential, to prevent the acquisition and transmission of infectious diseases, yet its use is often sub-optimal in the clinical setting. Training and education are important to ensure and sustain the safe and effective use of PPE by medical interns, but current methods are often inadequate in providing the relevant knowledge and skills. The purpose of this study was to explore medical graduates' experiences of the use of PPE and identify opportunities for improvement in education and training programmes, to improve occupational and patient safety. METHODS:This study was undertaken in 2018 in a large tertiary-care teaching hospital in Sydney, Australia, to explore medical interns' self-reported experiences of PPE use, at the beginning of their internship. Reflexive groups were conducted immediately after theoretical and practical PPE training, during hospital orientation. Transcripts of recorded discussions were analysed, using a thematic approach that drew on the COM-B (capability, opportunity, motivation - behaviour) framework for behaviour. RESULTS:80% of 90 eligible graduates participated. Many interns had not previously received formal training in the specific skills required for optimal PPE use and had developed potentially unsafe habits. Their experiences as medical students in clinical areas contrasted sharply with recommended practice taught at hospital orientation and impacted on their ability to cultivate correct PPE use. CONCLUSIONS:Undergraduate teaching should be consistent with best practice PPE use, and include practical training that embeds correct and safe practices

Patient involvement can affect clinicians’ perspectives and practices of infection prevention and control: A “post-qualitative” study using video-reflexive ethnography

© The Author(s) 2017. This study, set in a mixed, adult surgical ward of a metropolitan teaching hospital in Sydney, Australia, used a novel application of video-reflexive ethnography (VRE) to engage patients and clinicians in an exploration of the practical and relational complexities of patient involvement in infection prevention and control (IPC). This study included individual reflexive sessions with eight patients and six group reflexive sessions with 35 nurses. VRE usually involves participants reflecting on video footage of their own (and colleagues’) practices in group reflexive sessions. We extended the method here by presenting, to nurses, video clips of their clinical interactions with patients, in conjunction with footage of the patients themselves analyzing the videos of their own care, for infection risks.We found that this novel approach affected the nurses’ capacities to recognize, support, and enable patient involvement in IPC and to reflect on their own, sometimes inconsistent, IPC practices from patients’ perspectives. As a “post-qualitative” approach, VRE prioritizes participants’ roles, contributions, and learning. Invoking affect as an explanatory lens, we theorize that a “safe space” was created for participants in our study to reflect on and reshape their assumptions, positionings, and practices

To follow a rule? On frontline clinicians’ understandings and embodiments of hospital-acquired infection prevention and control rules

© The Author(s) 2018. This article reports on a study of clinicians’ responses to footage of their enactments of infection prevention and control. The study’s approach was to elicit clinicians’ reflections on and clarifications about the connections among infection control activities and infection control rules, taking into account their awareness, interpretation and in situ application of those rules. The findings of the study are that clinicians responded to footage of their own infection prevention and control practices by articulating previously unheeded tensions and constraints including infection control rules that were incomplete, undergoing change, and conflicting; material obstructions limiting infection control efforts; and habituated and divergent rule enactments and rule interpretations that were problematic but disregarded. The reflexive process is shown to elicit clinicians’ learning about these complexities as they affect the accomplishment of effective infection control. The process is further shown to strengthen clinicians’ appreciation of infection control as necessitating deliberation to decide what are locally appropriate standards, interpretations, assumptions, habituations and enactments of infection control. The article concludes that clinicians’ ‘practical wisdom’ is unlikely to reach its full potential without video-assisted scrutiny of and deliberation about in situ clinical work. This enables clinicians to anchor their in situ enactments, reasonings and interpretations to local agreements about the intent, applicability, limits and practical enactment of rules

An innovative approach to strengthening health professionals’ infection control and limiting hospital-acquired infection: video-reflexive ethnography

Objective To strengthen clinicians’ infection control awareness and risk realisation by engaging them in scrutinising footage of their own infection control practices and enabling them to articulate challenges and design improvements. Design and participants Clinicians and patients from selected wards of 2 hospitals in western Sydney. Main outcome measures Evidence of risk realisation and new insights into infection control as articulated during video-reflexive feedback meetings. Results Frontline clinicians identified previously unrecognised infection risks in their own practices and in their team's practices. They also formulated safer ways of dealing with, for example, charts and patient transfers. Conclusions Video-reflexive ethnography enables frontline clinicians to identify infection risks and to design locally tailored solutions for existing risks and emerging ones

Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination in hospital wards

Background Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. Methods We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. Results We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving ‘from clean to dirty’ when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning. Conclusions Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.Funding source NHMRC APP100917

The roles of motivation and ability in controlling the consequences of stereotype suppression

Two experiments investigated the conditions under which previously suppressed stereotypes are applied in impression formation. In Experiment 1, the extent to which a previously suppressed racial stereotype influenced subsequent impressions depended on the race of the target who was subsequently encountered. Whereas impressions of race-unspecified targets were assimilated to the stereotype following its suppression, no such effects were observed when the target belonged to the racial group whose stereotype had been initially suppressed. These results demonstrate that when perceivers are motivated to avoid stereo-typing individuals, the influence of a stereotype that has been previously activated through suppression is minimized. Experiment 2 demonstrated that these processing goals effectively reduce the impact of suppression-activated stereotypes only when perceivers have sufficient capacity to enact the goals. These results suggest that both sufficient motivation and capacity are necessary to prevent heightened stereotyping following stereotype suppression

To follow a rule? On frontline clinicians’ understandings and embodiments of hospital-acquired infection prevention and control rules.

This article reports on a study of clinicians’ responses to footage of their enactments of infection prevention and control. The study’s approach was to elicit clinicians’ reflections on and clarifications about the connections among infection control activities and infection control rules, taking into account their awareness, interpretation, and in situ application of those rules. The findings of the study are that clinicians responded to footage of their own IPC practices by articulating previously unheeded tensions and constraints including: infection control rules that were incomplete, undergoing change, and conflicting; material obstructions limiting infection control efforts; and habituated and divergent rule enactments and rule interpretations that were problematic but disregarded. The reflexive process is shown to elicit clinicians’ learning about these complexities as they affect the accomplishment of effective infection control. The process is further shown to strengthen clinicians’ appreciation of infection control as necessitating deliberation to decide what are locally appropriate standards, interpretations, assumptions, habituations and enactments of infection control. The article concludes that clinicians’ ‘practical wisdom’ is unlikely to reach its full potential without video-assisted scrutiny of and deliberation about in situ clinical work. This enables clinicians to anchor their in situ enactments, reasonings and interpretations to local agreements about the intent, applicability, limits and practical enactment of rules. Key words: video-reflexivity, rules, infection control, patient safety, embodied practice, practical wisdom, abductio