‘Working with the team’ : an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care

This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants’ responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.

A qualitative analysis of stress, uplifts and coping in the personal and professional lives of Singaporean nurses.

Aim. This paper is a report of a descriptive study of nurses’ experiences of daily stress and coping. Background. Much of the research on stress in nursing is quantitative and has focused on only work stressors. Moreover, few studies have examined the uplifting side of living and the role it may play in moderating stress. A theoretical framework on stress and coping, ‘hassles’ and ‘uplifts’ was used to examine nurses’ experiences across their personal and professional lives from a qualitative perspective. Methods. A purposive sample of Singaporean hospital nurses (n = 23) identified using a snowball sampling technique, participated in two sets of email interviews in 2009. The qualitative data were analysed using thematic analysis. Results. Three themes were identified as constituting daily hassles: (i) time pressures, (ii) nature of nursing work and (iii) multiple roles. Uplifts were expressed in relation to one main theme of feeling good extending across nurses’ personal and professional lives. Three themes were identified as ways of coping: (i) taking time out, (ii) seeking emotional support and (iii) belief systems. Conclusion. The interaction between personal and professional life plays a major role in Singaporean nurses’ experiences of stress and coping. However, stress may be ameliorated through effective management and strong familial support. Nurses and employers are recommended to use uplifts and identify ways of coping to minimize attrition and contribute to the development of a healthy workforce.

Hepatitis C : a socio-cultural perspective on the effects of a new virus on a community’s health

Since the emergence of diagnostic medical tests in Australia in 1990, hepatitis C (HCV) has been shown to account for over 90 percent of all non-A non-B hepatitis, revealing it to be a widespread and major public health problem. The diagnosis of HCV involves a diverse range of issues for affected persons, introducing identity and lifestyle changes, which are commonly articulated through psychological concepts. In this article we argue that it is important to examine the broader social and cultural contexts that contribute to the experiences of persons affected by HCV. The thematic analysis of qualitative data from six individuals diagnosed with HCV is included to exemplify some of the processes that are involved in the changing identity of a person following a positive diagnosis. The theoretical framework for the interpretation of these processes is interpretive interactionism. In this research, we are attempting to extend the understanding of the effects of HCV diagnoses beyond internal, psychological processes by examining how these diagnoses transform some of the processes of self-formation and expression. The participants’ experiences indicate that there are at least four dimensions of self that were significant to their changing sense of self: relationship of self to others; the emotional self; self-stories and identity; and self-scrutiny and relationships. We conclude that a socio-cultural perspective contributes to the explanation of the transition period following a HCV-positive diagnosis and the redefinition of self towards a HCV status.

Land use planning and the airport metropolis

Australian airports have emerged as important urban activity centres over the past decade as a result of privatisation. A range of reciprocal airport and regional impacts now pose considerable challenges for both airport operation and the surrounding urban and regional environment. The airport can no longer be managed solely as a specialised transport entity in isolation from the metropolis that it serves. In 2007 a multidisciplinary Australian Research Council Linkage Project (LP 0775225) was funded to investigate the changing role of airports in Australia. This thesis is but one component of this collaborative research effort. Here the issues surrounding the policy and practice of airport and regional land use planning are explored, analysed and detailed. This research, for the first time, assembles a distinct progression of the wider social, economic, technological and environmental roles of the airport within the Australian airport literature from 1914 – 2011. It recognises that while the list of airport and regional impacts has grown through time, treatment within practice and the literature has largely remained highly specialised and contained within disciplinary paradigms. The first publication of the thesis (Chapter 2) acknowledges that the changing role of airports demands the establishment of new models of airport planning and development. It argues that practice and research requires a better understanding of the reciprocal impacts of airports and their urban catchments. The second publication (Chapter 3) highlights that there is ad hoc examination and media attention of high profile airport and regional conflict, but little empirical analysis or understanding of the extent to which all privatised Australian airports are intending to develop. The conceptual and methodological significance of this research is the development of a national land use classification system for on-airport development. This paper establishes the extent of on-airport development in Australia, providing insight into the changing land use and economic roles of privatised airports. The third publication (Chapter 4) details new and significant interdependencies for airport and regional development in consideration of the progression of airports as activity centres. Here the model of an ‘airport metropolis’ is offered as an organising device and theoretical contribution for comprehending the complexity and planning of airport and regional development. It delivers a conceptual framework for both research and policy, which acknowledges the reciprocal impacts of economic development, land use, infrastructure and governance ‘interfaces’. In a timely and significant concurrence with this research the Australian Government announced and delivered a National Aviation Policy Review (2008 – 2009). As such the fourth publication (Chapter 5) focuses on the airport and urban planning aspects of the review. This paper also highlights the overall policy intention of facilitating broader airport and regional collaborative processes. This communicative turn in airport policy is significant in light of the communicative theoretical framework of the thesis. The fifth paper of the thesis (Chapter 6) examines three Australian case studies (Brisbane, Adelaide and Canberra) to detail the context of airport and regional land use planning and to apply the airport metropolis model as a framework for research. Through the use of Land Use Forums, over 120 airport and regional stakeholders are brought together to detail their perspectives and interactions with airport and regional land use planning. An inductive thematic analysis of the results identifies three significant themes which contribute to the fragmentation of airport and regional and land use planning: 1) inadequate coordination and disjointed decision-making; 2) current legislative and policy frameworks; and 3) competing stakeholder priorities and interests. Building on this new knowledge, Chapter 7 details the perceptions of airport and local, state and territory government stakeholders to land use relationships, processes and outcomes. A series of semi-structured interviews are undertaken in each of the case studies to inform this research. The potential implications for ongoing communicative practice are discussed in conclusion. The following thesis represents an incremental and cumulative research process which delivers new knowledge for the practical understanding and research interpretation of airport and regional land use planning practice and policy. It has developed and applied a robust conceptual framework which delivers significant direction for all stakeholders to better comprehend the relevance of airports in the urban character and design of our cities.

Multiple Literacies Theory: Discourse, sensation, resonance and becoming

This thematic issue on education and the politics of becoming focuses on how a Multiple Literacies Theory (MLT) plugs into practice in education. MLT does this by creating an assemblage between discourse, text, resonance and sensations. What does this produce? Becoming AND how one might live are the product of an assemblage (May, 2005; Semetsky, 2003). In this paper, MLT is the approach that explores the connection between educational theory and practice through the lens of an empirical study of multilingual children acquiring multiple writing systems simultaneously. The introduction explicates discourse, text, resonance, sensation and becoming. The second section introduces certain Deleuzian concepts that plug into MLT. The third section serves as an introduction to MLT. The fourth section is devoted to the study by way of a rhizoanalysis. Finally, drawing on the concept of the rhizome, this article exits with potential lines of flight opened by MLT. These are becomings which highlight the significance of this work in terms of transforming not only how literacies are conceptualized, especially in minority language contexts, but also how one might live.

“As many options as there are, there are just not enough for me” : a qualitative analysis of contraceptive use and barriers to access among Australian women

There is currently little information available about reasons for contraceptive use or non-use among young Australian women and the reasons for choosing specific types of contraceptive methods. A comprehensive life course perspective of women's experiences in using and obtaining contraceptives is lacking, particularly relating to women's perceived or physical barriers to access. This paper presents an analysis of qualitative data gathered from free-text comments provided by women born between 1973 and 1978 as part of their participation in the Australian Longitudinal Study on Women's Health. The Australian Longitudinal Study on Women's Health is a large cohort study involving over 40,000 women from three age groups (aged 18-23, aged 40-45 and aged 70-75) who were selected from the database of Medicare the Australian universal health insurance system in 1995. The women have been surveyed every 3 years about their health by mailed self-report surveys, and more recently online. Written comments from 690 women across five surveys from 1996 (when they were aged 18-23 years) to 2009 (aged 31-36 years) were examined. Factors relating to contraceptive use and barriers to access were identified and explored using thematic analysis. Side-effects, method satisfaction, family timing, and hormonal balance were relevant to young women using contraception. Most women who commented about a specific contraceptive method wrote about the oral contraceptive pill. While many women were positive or neutral about their method, noting its convenience or non-contraceptive benefits, many others were concerned about adverse effects, affordability, method failure, and lack of choice. Negative experiences with health services, lack of information, and cost were identified as barriers to access. As the cohort aged over time, method choice, changing patterns of use, side-effects, and negative experiences with health services remained important themes. Side-effects, convenience, and family timing play important roles in young Australian women's experiences of contraception and barriers to access. Contrary to assumptions, barriers to contraceptive access continue to be experienced by young women as they move into adulthood. Further research is needed about how to decrease barriers to contraceptive use and minimise negative experiences in order to ensure optimal contraceptive access for Australian women.

Australian adolescents’ perceived school-based barriers and facilitators to engagement in physical activity

OBJECTIVE: School-aged youth spend a significant amount of time either in transit to and from school, or within school settings performing a range of varying learning-based activities. Adolescent physical activity has also been shown to increase the likelihood of maintaining physical activity throughout adulthood. The purpose of this study is to investigate adolescents’ perceived school-based barriers and facilitators to engagement in physical activity. METHODS: One-hundred and twenty four participants (38 males and 86 females) were recruited from two non-denominational same-sex private schools, in Brisbane, Australia. The mean age and standard deviation (SD) was 13.83 (0.56) and 14.40 (2.33) for males and females respectively. Participants responded to a series questions regarding perceived barriers and facilitators to engagement in physical activity. Quantitative data was analysed using descriptive statistics and frequency distributions, and qualitative data with thematic analysis. RESULTS: A total of 121 (97.6%) participants had complete data sets and were included in the analysis. School timetable (44.6%), homework (81.8%), and assessment (81.0%) were identified as the most prominent perceived factors, increasing the difficulty of physical activity engagement. Physical Education classes (71.9%) and school sport programs (80.2%) were identified as the most prominent perceived factors that facilitate engagement in physical activity. There was no significant gender effect. CONCLUSIONS: Each of the identified factors perceived by adolescent's as either barriers or facilitators to engagement in physical activity may be addressed by administrators at a school and government policy level. These may include strategies such as; increasing the assigned hours to physical education classes, providing additional extra-curricular sporting opportunities, and reviewing the time allocated to homework and assessment items. This may provide a simpler, low-cost solution to increasing youth physical activity, as opposed to contemporary higher-cost strategies utilising increased staff commitment, mass media, provision of equipment and counsellors and other health professionals.

Grunt language versus accent : the perceived communication barriers between international medical graduates and patients in Central Wheatbelt catchments

Due to the chronic shortages of GPs in Australian rural and remote regions, considerable numbers of international medical graduates (IMG) have been recruited. IMG experience many difficulties when relocating to Australia with one of the most significant being effective GP-patient communication. Given that this is essential for effective consultation it can have a substantial impact on health care. A purposive sample of seven practising GPs (five IMG, two Australian-trained doctors (ATD)) was interviewed using a semistructured face-to-face interviewing technique. GPs from Nigeria, Egypt, United Kingdom, India, Singapore and Australia participated. Interviews were transcribed and then coded. The authors used qualitative thematic analysis of interview transcripts to identify common themes. IMG-patient communication barriers were considered significant in the Wheatbelt region as identified by both IMG and ATD. ATD indicated they were aware of IMG-patient communication issues resulting in subsequent consults with patients to explain results and diagnoses. Significantly, a lack of communication between ATD and IMG also emerged, creating a further barrier to effective communication. Analysis of the data generated several important findings that rural GP networks should consider when integrating new IMG into the community. Addressing the challenges related to cross-cultural differences should be a priority, in order to enable effective communication. More open communication between ATD and IMG about GP-patient communication barriers and education programs around GP-patient communication would help both GP and patient satisfaction.

Point of no return : exploring katabatic narrative and deterritorialisation in the Australian outback novel

This thesis consists of the novel Brolga and an exegesis examining in what ways the ideas of katabasis and deterritorialisation inform an understanding of descent narratives in contemporary Australian outback fiction. When writing the creative piece, it was observed that Joseph Campbell’s Hero’s Journey was an imprecise model for my manuscript and indeed for many of the contemporary novels I had read written in similar outback settings. On analysis a better fit lies in the idea of a heroic journey from which there is no clear return from the underworld. This narrative form is defined in this thesis as a katabatic narrative. To unpack this narrative trope, the inverse of territoriality, deterritorialisation, is used as a lens to examine the complex thematic and symbolic resonances of the outback in both Brolga and analogous works of contemporary outback fiction.

Australian and New Zealand nurses’ perceptions of procedural sedation and analgesia in the cardiac catheterisation laboratory : a qualitative study

Background: Australian and New Zealand College of Anaesthetists’ guidelines for procedural sedation and analgesia (PSA) are intended to apply across all clinical settings. As nurses are frequently responsible for patient care during PSA in the cardiac catheterisation laboratory (CCL), their perspectives can provide insight into the effectiveness of these guidelines within this particular setting. Methods: A cross-sectional sampling design was used to recruit nurses from urban, regional, public and private CCLs across Australia and New Zealand. Semi-structured interviews were conducted, digitally recorded and transcribed. Data were analysed using thematic analysis. Findings: Twenty-three nurses from 16 CCLs across four states in Australia and New Zealand participated. Most held senior positions (managers=14; educators=5) and CCL experience ranged from 4 to 26 years (mean 11). Participants were concerned about the legitimacy of their practice as they administered PSA outside of guideline recommendations and deemed present education and training as deficient. Participants noted also that guideline recommendations were sometimes not adhered to as it was difficult to balance the increasingly complex PSA requirements of their case-mix with limited access to anaesthetists while trying not to delay procedures. Conclusion: Findings suggest that application of current PSA guidelines may be impractical for CCL nurses and, as a consequence, they are often not followed. Participants were concerned about risks to patient safety as they felt education and training was not commensurable with practice requirements. The findings suggest existing guidelines should be reviewed or new guidelines developed which address nursing practice, education and competency standards for PSA in the CCL

What should I say?: Qualitative findings on dilemmas in palliative care nursing

The nursing literature suggests that talking and listening to patients about issues associated with death and dying, is both important and difficult, and may be improved with training. This discussion presents the results of recent nursing research to confirm, and elaborate on, this theme. In this research participants touched on many central issues in communicating with patients that included articulating a sense of discomfort and inadequacy about the whole process, detailing the innumerable blocks to open communication [e.g., interference, denial, unrealistic optimism, resistance, collusion and anger] and sharing their sense of success and failure. The insights of nurses who participated in this research testify to the ongoing need to prioritize the development of nursing skills and support in this challenging but important area.

The confidence of speech-language pathology students regarding communicating with people with aphasia

Background Aphasia is an acquired language disorder that can present a significant barrier to patient involvement in healthcare decisions. Speech-language pathologists (SLPs) are viewed as experts in the field of communication. However, many SLP students do not receive practical training in techniques to communicate with people with aphasia (PWA) until they encounter PWA during clinical education placements. Methods This study investigated the confidence and knowledge of SLP students in communicating with PWA prior to clinical placements using a customised questionnaire. Confidence in communicating with people with aphasia was assessed using a 100-point visual analogue scale. Linear, and logistic, regressions were used to examine the association between confidence and age, as well as confidence and course type (graduate-entry masters or undergraduate), respectively. Knowledge of strategies to assist communication with PWA was examined by asking respondents to list specific strategies that could assist communication with PWA. Results SLP students were not confident with the prospect of communicating with PWA; reporting a median 29-points (inter-quartile range 17–47) on the visual analogue confidence scale. Only, four (8.2%) of respondents rated their confidence greater than 55 (out of 100). Regression analyses indicated no relationship existed between confidence and students‘ age (p = 0.31, r-squared = 0.02), or confidence and course type (p = 0.22, pseudo r-squared = 0.03). Students displayed limited knowledge about communication strategies. Thematic analysis of strategies revealed four overarching themes; Physical, Verbal Communication, Visual Information and Environmental Changes. While most students identified potential use of resources (such as images and written information), fewer students identified strategies to alter their verbal communication (such as reduced speech rate). Conclusions SLP students who had received aphasia related theoretical coursework, but not commenced clinical placements with PWA, were not confident in their ability to communicate with PWA. Students may benefit from an educational intervention or curriculum modification to incorporate practical training in effective strategies to communicate with PWA, before they encounter PWA in clinical settings. Ensuring students have confidence and knowledge of potential communication strategies to assist communication with PWA may allow them to focus their learning experiences in more specific clinical domains, such as clinical reasoning, rather than building foundation interpersonal communication skills.

A three-dimensional analysis of power and engaged scholarship

This dissertation investigates the nature of power in university-industry linkages and how such power affects the process of knowledge production in engaged scholarship. The most critical finding of this dissertation is that the theory of engaged scholarship fails to account for the socialised beliefs regarding the superior value of academic knowledge, which governs the behaviour and perceptions of academics and industry partners within university-industry linkages. The dissertation is supported by data sourced from interviews with 48 academic and industry partners’ project leaders from 24 large scale research projects and thematic analysis guided by Steven Lukes’ (1974) radical framework of power.

Modelling the information seeking user by the decision they make

The article focuses on how the information seeker makes decisions about relevance. It will employ a novel decision theory based on quantum probabilities. This direction derives from mounting research within the field of cognitive science showing that decision theory based on quantum probabilities is superior to modelling human judgements than standard probability models [2, 1]. By quantum probabilities, we mean decision event space is modelled as vector space rather than the usual Boolean algebra of sets. In this way,incompatible perspectives around a decision can be modelled leading to an interference term which modifies the law of total probability. The interference term is crucial in modifying the probability judgements made by current probabilistic systems so they align better with human judgement. The goal of this article is thus to model the information seeker user as a decision maker. For this purpose, signal detection models will be sketched which are in principle applicable in a wide variety of information seeking scenarios.

A class B switch-mode assisted linear amplifier

A switch-mode assisted linear amplifier (SMALA) combining a linear (Class B) and a switch-mode (Class D) amplifier is presented. The usual single hysteretic controlled half-bridge current dumping stage is replaced by two parallel buck converter stages, in a parallel voltage controlled topology. These operate independently: one buck converter sources current to assist the upper Class B output device, and a complementary converter sinks current to assist the lower device. This topology lends itself to a novel control approach of a dead-band at low power levels where neither class D amplifier assists, allowing the class B amplifier to supply the load without interference, ensuring high fidelity. A 20 W implementation demonstrates 85% efficiency, with distortion below 0.08% measured across the full audio bandwidth at 15 W. The class D amplifier begins assisting at 2 W, and below this value, the distortion was below 0.03%. Complete circuitry is given, showing the simplicity of the additional class D amplifier and its corresponding control circuitry.