The interface of acute and aged care : the role of the nurse in a provincial area

Objective This study was to investigate issues that arose from pre-admission to post-discharge, for people in Toowoomba, Queensland over the age of 65 admitted to an acute facility. This paper concentrates on a significant concern that emerged from the large amount of data collected during this project, that is,the role of the nurse in the continuum of health care involving elderly people. Method The study involved a multi-site, multi-agency and multi-method (qualitative and quantitative) approach. Data was collected from regional service providers, the Department of Health and Aged Care (DHAC), the Australian Bureau of Statistics (ABS), Home and Community Care (HACC), the Aged Care Assessment Team (ACAT), elderly people who had been discharged from regional hospitals and their carers, residents of regional aged care facilities, area health professionals and elderly regional hospital inpatients. Results The data indicated that nurses in this provincial area currently play a limited role in preadmission planning, being mostly concerned with elective surgery, especially joint replacements. While nurses deliver the majority of care during hospitalisation, they do not appear to be cognizant of the needs of the elderly regarding post-acute discharge. Conclusion The recent introduction of the model of nurse case management in the acute sector appears to be a positive development that will streamline and optimise the health care of the elderly across the continuum in the Toowoomba area. The paper recommends some strategies, such as discharge liaison nurses based in Emergency Departments and the expansion of the nurse case management role, which would optimise care for the elderly person at the interface of care.

Experiences of regional and rural people with cancer being treated with radiotherapy in a metropolitan centre

This paper explores the issues related to rural people with cancer whose choice of radiotherapy treatment necessitated travel and accommodation in a metropolitan centre. Semi-structured interviews with 46 participants, from the Toowoomba and Darling Downs region of Queensland, Australia, were conducted and the data thematically analysed. The specific themes identified were: being away from loved ones, maintaining responsibilities whilst undergoing treatment, emotional stress, burden on significant others, choice about radiotherapy as a treatment, travel and accommodation, and financial burden. This study supports the need for a radiotherapy centre in the location of Toowoomba as a way of providing some equity and access to such treatment for the rural people of Queensland.

“A politics of what” : A praxiography of renal disease in Indigenous renal patients

The morbidity and mortality rates of renal disease in Indigenous Australians are significantly higher than those of non-Indigenous Australians, and are increasing. The dominant discourses of renal disease currently predicate this as essentially a client problem, rather than (for example) a health care system problem. These discourses are indicative of the dominant “white” paradigm of health care, which fosters an expectation of assimilation by the marginalised “other.” In this paper, we draw upon a sociological methodology (the actor network approach) and a qualitative method (discourse analysis) to tease out these issues in Indigenous renal disease. Based on empirical data, we explore on the one hand the requirements of the discourses, technologies and practices that have been developed for a particular type of renal patient and health system in Australia. On the other, we examine the cultural and practical specificities entailed in the performance of these technologies and practices in the Indigenous Australian context. The meeting of the praxiographic orientation of the actor network approach—which has been called “the politics of what” (Mol 2002)—and the sociocultural concerns of discourse analysis does provide a useful guide as to “what to do” when confronted with issues in health care that currently seems unfathomable. Our praxiographic analysis of the discourse enabled us to understand the difficulties involved in translating renal health care networks across cultural contexts in Australia and to understand the dynamic and contested nature of these networks. The actor network approach has its limitations, however, particularly in the articulation of possible strategies to align two disparate systems in a way that would ensure better health care for Indigenous renal patients. In this paper we will discuss some of the problems we encountered in drawing on this methodology in our attempt to unearth practical solutions to the conundrums our data presented.

Settlement outcomes in sexual harassment complaints

This article examines the dispute resolution process of conciliation through a detailed study of Australian workplace sexual harassment complaints. It links two data sets: settlement details of a census of conciliated complaints lodged under all federal, State, and Territory anti-discrimination laws in a six-month period; and interviews undertaken with 71 professionals who have extensive, first-hand experience of conciliation processes in anti-discrimination jurisdictions. The article provides a critique of the effectiveness of conciliation as a form of ADR within the individualised constraints of current anti-discrimination laws.

Evaluating the use of online synchronous communication to enhance learning in statistics

According to social constructivists, learners are active participants in constructing new knowledge in a social process where they interact with others. In these social settings teachers or more knowledgeable peers provide support. This research study investigated the contribution that an online synchronous tutorial makes to support teaching and learning of undergraduate introductory statistics offered by an Australian regional university at a distance. The introductory statistics course which served as a research setting in this study was a requirement of a variety of programs at the University, including psychology, business and science. Often students in these programs perceive this course to be difficult and irrelevant to their programs of study. Negative attitudes and associated anxiety mean that students often struggle with the content. While asynchronous discussion forums have been shown to provide a level of interaction and support, it was anticipated that online synchronous tutorials would offer immediate feedback to move students forward through ―stuck places.‖ At the beginning of the semester the researcher offered distance students in this course the opportunity to participate in a weekly online synchronous tutorial which was an addition to the usual support offered by the teaching team. This tutorial was restricted to 12 volunteers to allow sufficient interaction to occur for each of the participants. The researcher, as participant-observer, conducted the weekly tutorials using the University's interactive online learning platform, Wimba Classroom, whereby participants interacted using audio, text chat and a virtual whiteboard. Prior to the start of semester, participants were surveyed about their previous mathematical experiences, their perceptions of the introductory statistics course and why they wanted to participate in the online tutorial. During the semester, they were regularly asked pertinent research questions related to their personal outcomes from the tutorial sessions. These sessions were recorded using screen capture software and the participants were interviewed about their experiences at the end of the semester. Analysis of these data indicated that the perceived value of online synchronous tutorial lies in the interaction with fellow students and a content expert and with the immediacy of feedback given. The collaborative learning environment offered the support required to maintain motivation, enhance confidence and develop problemsolving skills in these distance students of introductory statistics. Based on these findings a model of online synchronous learning is proposed.

A metastatic neuroendocrine anaplastic small cell tumor in a patient with multiple endocrine neoplasia type 1 syndrome : assessment of disease status and response to doxorubicin, cyclophosphamide, etoposide chemotherapy through scintigraphic imaging with 111In-pentetreotide

Extrapulmonary small cell and small cell neuroendocrine tumors of unknown primary site are, in general, aggressive neoplasms with a short median survival. Like small cell lung cancer (SCLC), they often are responsive to chemotherapy and radiotherapy. Small cell lung cancer and well differentiated neuroendocrine carcinomas of the gastrointestinal tract and pancreas tend to express somatostatin receptors. These tumors may be localized in patients by scintigraphic imaging using radiolabeled somatostatin analogues. A patient with an anaplastic neuroendocrine small cell tumor arising on a background of multiple endocrine neoplasia type 1 syndrome is reported. The patient had a known large pancreatic gastrinoma and previously treated parathyroid adenopathy. At presentation, there was small cell cancer throughout the liver and skeleton. Imaging with a radiolabeled somatostatin analogue, 111In- pentetreotide (Mallinckrodt Medical B. V., Petten, Holland), revealed all sites of disease detected by routine biochemical and radiologic methods. After six cycles of chemotherapy with doxorubicin, cyclophosphamide, and etoposide, there was almost complete clearance of the metastatic disease. 111In-pentetreotide scintigraphy revealed uptake consistent with small areas of residual disease in the liver, the abdomen (in mesenteric lymph nodes), and posterior thorax (in a rib). The primary gastrinoma present before the onset of the anaplastic small cell cancer showed no evidence of response to the treatment. The patient remained well for 1 year and then relapsed with brain, lung, liver, and skeletal metastases. Despite an initial response to salvage radiotherapy and chemotherapy with carboplatin and dacarbazine, the patient died 6 months later.

Ethics, Law and Health Care : a Guide for Nurses and Midwives

Understanding ethics and law in health care is an essential part of nurses’ and midwives’ professional standards. Ethics, Law and Health Care focuses on teaching applied ethics and law in a manner that illustrates the real world applications of these core components of the nursing and midwifery curriculum and practice. It equips readers with the ability to recognise and address legal and ethical issues that will arise in their professional practice. The book uses the four principles of biomedical ethics (autonomy, non-maleficence, beneficence and justice) together with the use of both the Nursing and Midwifery Codes of Ethics and Codes of Professional Conduct, issued by the Nursing and Midwifery Board of Australia, as a central means through which to analyse and approach ethical and legal issues. Ethics, Law and Health Care is scaffolded to assist readers in understanding legal and ethical principles, to integrate them in the context of a particular issue within professional practice, and provide them with a decision-making framework to take action in a professional context by utilising the Codes as well as state and federal law. Aided by pedagogical features such as case studies, review questions, further reading and a glossary of common terms, this book is an essential resource for students, academics and practitioners.

‘We’ve always cooked kangaroo. We still cook kangaroo. Although sometimes we use cookbooks now’ : Aboriginal Australians and cookbooks

Aboriginal Australians have a long history of eating native animals and plants. Food preparation techniques were handed down through the generations, without any need for cookbooks. But colonisation changed the diets of Aboriginal Australians, introducing us to a processed diet high in salt, sugar and fat, and causing a wide range of diet-related health problems. Over the years, many Aboriginal Australians lost their connections to traditional food preparation practices. In this paper, the authors provide a brief overview of Aboriginal food history and describe a newly-emerging focus on reintroducing native foods. They describe the work of an Aboriginal chef, Dale Chapman, who is actively promoting native foods and creating a native-Western food fusion. Chapman has developed native food recipes and a cookbook, in an effort to make native foods accessible to all Australians. She promotes a future when native foods are part of the identity of all Australians – both Aboriginal and non-Aboriginal.

Asking for it? Practices and structures that perpetuate employee silence in pursuing customised work arrangements

A component of broader scholarship addressing the social context in which individuals work, has focused on the role of ‘employee voice’ in determining flexible-work outcomes (Donnelly et al., 2012). Employee voice incorporates a spectrum of practices designed to give employees a say in organisational decisions (Dundon et al., 2004). This paper extends work on voice and workplace flexibility in two ways. First, it focuses not simply on ‘voice’ but on its antithesis, employee silence, which is defined (following Van Dyne et al., 2003) as the intentional withholding of ideas and opinions. We utilise an alternative reading of silence to the majority of literature which interprets it as a product of employee motivation, by focusing on the role of management and by adopting a framework which considers silence as a control dialectic (Donaghey et al., 2011). Second, the study examines silence with respect to preferences for customising the terms/conditions of employment beyond narrowly defined notions of ‘flexible work’ (e.g., reduced hours; home-working). The study utilises 30 telephone interviews with employees who had been previously identified as ‘discontent non-requesters’ (Skinner and Pocock, 2011: 75), that is they had expressed a desire to request flexible working provisions, but had not done so. Interviewees were asked to articulate the reasons for, and consequences of, their silence. The findings reveal nuanced workplace practices and structures that close down possibilities for employee voice and perpetuate silence on matters relating to customising work. They also illustrate a disjuncture between espoused organizational goals and everyday practices and norms encountered in workplaces.

The sound of silence : the absence of voice in determining flexible working arrangements

In the context of a dramatically reconfigured labour market characterized by an individualistic culture and increasingly enmeshed life domains of employees, there is raised awareness of how employees may shape or modify their work arrangements. A small component of broader scholarship addressing issues that affect the social context in which individuals work, has focused on the role of ‘employee voice' in determining flexible-work outcomes (Donnelly et al., 2012). Employee voice is a broad term incorporating a spectrum of different practices designed to give employees a say in organisational issues and decisions (Dundon et al., 2004). This article extends work on voice and workplace flexibility by focusing not simply on ‘voice' but on its antithesis: employee silence. Silence is defined here, (following Van Dyne et al., 2003), as the intentional withholding of ideas, information and opinions. The consequences of employee silence in achieving work-life preferences are likely to be significant for both individuals and organizations, in achieving for example, the goals of business efficiency and facilitating employees' needs to fulfill multiple roles and minimize work-life interference.

Development of an evidence-based framework to guide injury prevention interventions for off-road motorcyclists

There is little research on off-road motorcycle and all-terrain vehicle riders though injury levels are high. This thesis identified formal responsibility for monitoring injuries, targeting young male and recreational riders, promotion of family members as models, and controlled and accessible riding locations as ways to increase safety. These recommendations were based on analysis of Queensland hospitalisation records, rider personal reports and survey responses.

The Australian welfare state : who benefits now?

This text outlines the links between Australian's conceptions about welfare and the redistributive outcomes of the welfare state, canvassing theoretical explanations about why many Australians develop and maintain misconceptions of the broad disyributive mechanisms of the Ayustralian welfare state and hold negative attitudes towards its social welfare element. The book is an indispensable resource for students undertaking studies in sociology, social policy, public administrion and social work.