Retrospective observational study of patients who present to Australian rural emergency departments with undifferentiated chest pain

Aim To identify the demographic and clinical characteristics of patients who present to Australian rural emergency departments with chest pain. Design Retrospective, observational study Setting Rural emergency departments (ED) in Queensland, Australia Participants 337 consecutive adult patients with undifferentiated chest pain that presented between 1st September 2013 and 30th November 2013. Main outcome measures Service indicators, discharge diagnoses and disposition Results Presentations for undifferentiated chest pain represented 3.5% of all patient presentations during the sampling period. The mean age of patients was 48 years and 54% were male. Overall, 92% of patients left the ED within the 4-hour NEAT target. The majority of presentations were related to cardiac concerns (39%), followed by non-cardiac chest pain (17%), musculoskeletal (15%) and respiratory (10%) conditions. More than half of these patients were discharged at the completion of the ED service (52.8%), 40.6% were admitted, 3.3% left at own risk, 2.4% did not wait and less than 1% of patients required transfer to another hospital directly from the ED. Conclusions This study has provided information on the characteristics and processes of care for patients presenting to Australian rural EDs with undifferentiated chest pain that will inform service planning and further research to evaluate the effectiveness of care for these patients.

Degree of value alignment : a grounded theory of rural nurse resignations

INTRODUCTION: The shortage of nurses willing to work in rural Australian healthcare settings continues to worsen. Australian rural areas have a lower retention rate of nurses than metropolitan counterparts, with more remote communities experiencing an even higher turnover of nursing staff. When retention rates are lower, patient outcomes are known to be poorer. This article reports a study that sought to explore the reasons why registered nurses resign from rural hospitals in the state of New South Wales, Australia. METHODS: Using grounded theory methods, this study explored the reasons why registered nurses resigned from New South Wales rural hospitals. Data were collected from 12 participants using semi-structured interviews; each participant was a registered nurse who had resigned from a rural hospital. Nurses who had resigned due to retirement, relocation or maternity leave were excluded. Interviews were transcribed verbatim and imported into NVivo software. The constant comparative method of data collection and analysis was followed until a core category emerged. RESULTS: Nurses resigned from rural hospitals when their personal value of how nursing should occur conflicted with the hospital's organisational values driving the practice of nursing. These conflicting values led to a change in the degree of value alignment between the nurse and hospital. The degree of value alignment occurred in three dynamic stages that nurses moved through prior to resigning. The first stage, sharing values, was a time when a nurse and a hospital shared similar values. The second stage was conceding values where, due to perceived changes in a hospital's values, a nurse felt that patient care became compromised and this led to a divergence of values. The final stage was resigning, a stage where a nurse 'gave up' as they felt that their professional integrity was severely compromised. The findings revealed that when a nurse and organisational values were not aligned, conflict was created for a nurse about how they could perform nursing that aligned with their internalised professional values and integrity. Resignation occurred when nurses were unable to realign their personal values to changed organisational values - the organisational values changed due to rural area health service restructures, centralisation of budgets and resources, cumbersome hierarchies and management structures that inhibited communication and decision making, out-dated and ineffective operating systems, insufficient and inexperienced staff, bullying, and a lack of connectedness and shared vision. CONCLUSIONS: To fully comprehend rural nurse resignations, this study identified three stages that nurses move through prior to resignation. Effective retention strategies for the nursing workforce should address contributors to a decrease in value alignment and work towards encouraging the coalescence of nurses' and hospitals' values. It is imperative that strategies enable nurses to provide high quality patient care and promote a sense of connectedness and a shared vision between nurse and hospital. Senior managers need to have clear ways to articulate and imbue organisational values and be explicit in how these values accommodate nurses' values. Ward-level nurse managers have a significant responsibility to ensure that a hospital's values (both explicit and implicit) are incorporated into ward culture.

Person-Centred Approaches to Private Housing for People with Disability : Impediments, Difficulties and Opportunities

Objective The main objective of the project was to explore the barriers and obstacles impeding a person-centred approach to planning and private housing for people with disability. Method Methodologically, the project involved explanation building using a multiple case study approach supported by a contextual study. It focussed initially on three organisations and their attempts to integrate innovative and what they regarded as person-centred models of housing into the private housing market for people with disability. It also included a fourth case highlighting the experiences of individuals with disability in accessing suitable and affordable housing. Results Using an ecological framework, the project found that: • Challenges exist within systems (such as the macro cultural, economic, regulatory systems through to local community, family and intra personal systems) as well as with interaction between systems • Reaching across systems is a key role for organisations and individuals but is very challenging with distance from the individual as well as from the policy/funding/service systems being a key aspect of the nature and extent by which they are challenged • In the case of housing for people with disability a ‘disability space’ is assumed and maintained disparately within each system and is separate from the ‘mainstream space’ with the established policy, legal, funding structures making it difficult to move between the two spaces. Conclusions Based on these findings, the project makes recommendations for government, community organisations, the housing industry, people with disability and their families and support networks, as well as for future research. An overarching recommendation is the need to address housing stock availability and suitability by adopting a mainstream approach rather than a disability-first/disability-specific approach.

Reshaping housing using prefabricated systems

Prefabricated housing innovations have the potential to reduce the environmental impact of construction through improvements to efficiency and quality. The current paper presents a number of recommendations for increasing the adoption of prefabrication based on a review of published evidence. The recommendations consider multiple stakeholders including builders and other intermediaries, suppliers, end-users, as well as their interaction with the broader policy context and technical issues

Developing affordable and sustainable housing through energy, transport, and building utility integration

Housing affordability and sustainable development are not polarised ideologies as both are necessary with increasing urbanisation. We must bridge the gap between current median house pricing and target affordable house pricing whilst pursuing sustainability. This paper examines the potential of initial construction cost and ongoing utilities and transport cost reduction through the integration of sustainable housing design and transit oriented development principles in a Commuter Energy and Building Utilities System (CEBUS). It also introduces current research on the development of a Dynamic Simulation Model for CEBUS applications in the Australian property development and construction industry.

Challenges facing the application of sustainability to housing in Saudi Arabia

Modern Saudi housing supply is neither sustainable nor efficient in meeting the conservative Islamic culture of the community and the local environmental conditions. This thesis develops a model for successful development of sustainable housing in Saudi Arabia by incorporating multi stakeholder inputs on key barriers, critical success factors and best practice case studies. The model will help create public awareness and education tools for both private and public sectors on sustainable housing. It provides a framework that includes cultural and environmental needs of the conservative Saudi neighbourhood. It may assist the Saudi government to regulate new building codes and regulations.

Fostering digital participation in regional and rural Australia

The deployment of high speed broadband around Australia offers opportunities to extend digital participation among and between regional and rural communities. Full realisation of these opportunities requires a greater understanding about community members’ current digital participation and development needs, to underpin innovative community-driven initiatives. This paper outlines the Fostering Digital Participation Project’s initial undertakings to determine current digital participation and the future digital aspirations of a number of regional and rural communities.

Youth off the Streets "Our Place, Walgett Youth and Young Families Project" Project Evaluation.

The Project: • YOTS is a major youth specific agency established in 1991. It is a non-denominational, non-discriminatory and not-for-profit organisation, providing a wide range of services and offering a full continuum of care. It seeks to build on the strengths and positive aspects of marginalised young people and communities. • The 'Our Place, Walgett Youth and Young Families Project' further develops an existing YOTS capacity to provide services to Aboriginal young people. • The project adopted an action-research and community development model in which YOTS worked in partnership with the Youth Sub-committee of the Walgett Interagency. • Specific goals/objectives of the program were to: Coordinate youth and young family activities in partnership with local services and the community to build self-esteem, pride, resilience, motivation and skills; Contribute to the prevention and reduction of homelessness, unstable and unsafe housing and disruptive mobility (Walgett/Redfern) in youth and young families; Increase and improve collaborative engagement between youth and family focused services; and, research, adapt and implement Australian and international best-practice homelessness prevention/reduction initiatives to contribute to new models of practice relevant to rural and regional areas. • The project centred around an out-reach model that focused on providing a safe space with relevant structured activities coordinated by YOTS youth and family workers. Through community and service provider consultation, it was proposed that local services could coordinate strategies and activities and run them, where possible, from the centre, providing ease of access in a safe and supportive context. • Specific activities included: Implementing regular meetings with the stakeholders and community representatives; Developing a Terms of Reference for YOTS presence in the Walgett community; Undertaking a community consultation prior to finalising program activities; Implementing a range of recreational activities (sports, music, arts and crafts) early on in the activity; Implementing young family support initiatives; implementing a volunteering program, including volunteer support to young families through intergenerational volunteering; running a series of Culture and Healing Camps in partnership with local Elders and other services; Running a series of Music Camps; Providing alternative education support and referrals in partnership with local schools; Researching, identifying and adapting other best-practice models.

Crime in rural Australia

As an academic who has spent a quarter of a century living, lecturing and researching in a rural community, I am often impressed by the discrepancies between the reality of rural life and its image in the public consciousness. At least two aspects of this are the most striking. First, there is often - especially, but not exclusively in English-speaking societies - the idea that rural communities represent the "real" or "true" aspects of a society's culture. For example, judging by the representations of rural Australia in the media, rural life is where we find the true Australian, the laconic, taciturn, but decent everyday man and woman, the "battlers", who are not corrupted by urban life. Such an attribution of genuineness to rurality is especially interesting given that the vast majority of contemporary Australians live in cities and that Australia is one of the most urbanised countries in the world. Second, and following from the first point, is the idea that rural areas remain somewhat behind the times, that somehow they are not quite part of the contemporary world. This is a mixed image as it combines both the negative idea of backwardness with the more positive one of a society that has not lost the virtues of stability and civility that we often feel is missing in the city. Both of these ideas combine in the popular image of rural communities as safe places in an increasingly dangerous world. In the popular mind it seems that there is an idea that whatever rural communities may lack in conveniences and sophistication, they remain places where you might walk down the street safely, leave your doors unlocked at night and raise your children confident that they will not be exposed to drugs, gangs and violence. Unfortunately, all of these ideas are fantasies. There is no reason to believe that the residents of rural communities are anymore the truer representations of Australian culture than the average suburbanite.

Young People and Crime in Rural Communities

Because childhood and adolescence are crucial phases in psycho-social development and the formation of responsible citizens, an unusual degree of attention and supervision is directed at the young (Bittner, 1976; Rose, 1989). Such is the moral frailty of youth that mere presence or 11 doing nothing" (Corrigan, 1979) can, under certain circumstances, excite adult anxieties as a harbinger of immediate or later danger. Delinquency and adolescent antisocial behaviour are not, therefore, a matter of objective, positivistic measurement and control, but are bound up with larger patterns of intergenerational relationships. These relationships are also conditioned by social and spatial environments.

Policing in Rural Australia: The country cop as law enforcer and local resident

The strategies and techniques that police officers employ are adaptations to the types of communities they serve and the law enforcement system of which they are part. Observations of policing in rural and urban areas of Australia indicate that, despite being part of a single state police service, officers develop working philosophies that are systematically adapted to the locations they serve. Bayley (1989) has observed that while crimes are policed in the city, people are policed in the country. Rural police officers often adopt a community-based model of policing in which officers become integrated into a community and establish compatible community relations. While this model can produce successful results, with integration into informal social networks providing police increased opportunities to solve crime, rural police regularly find themselves occupying competing roles of law enforcer and local resident. This chapter will outline how the organisation and structure of rural communities impacts upon policing, noting distinct issues associated with police work in rural settings. Before examining current aspects of rural policing, a brief discussion of the historical and cultural context of rural policing is provided.

Introduction - There's crime out there, but not as we know it: Rural criminology - the last frontier

The idea that crime is a predominantly urban phenomenon has been pervasive in criminology, so much so that Australian criminology textbooks do not recognise rural crime as a distinct phenomenon worthy of scholarly attention (see Chappell & Wilson, 2000; Goldsmith et al, 2003; White & Haines, 2004; White & Habibis, 2005). There are no chapters or sections in Australian texts which specifically examine rural crime, despite the inclusion of a range of topics that appear to provide a broad coverage of crime in its many temporal and spatial dimensions. Nor is there so much as an index reference to "rural" issues in criminology textbooks. The standardised syllabus for crime texts provides coverage of topics such as violent crime, public crime, delinquency, race and crime, gender and crime, and crime and social class. This canon is mirrored in international texts, most of which also fail to address the issue of rural crime, but make abundant reference to crime in various urban contexts (see Carrabine et al, 2004; Conklin, 2004). This is not to suggest that Australian texts fail to localise their subject matter.

Sex outside the city : sex work in rural and regional New South Wales

During the last decade 'prostitution' has been characterised as a 'social problem' throughout rural and regional New South Wales. As we show here, the urban-centric nature of popular and official discourses of prostitution have inadvertently allowed for the development of regulatory positions which have negatively impacted sex workers in rural and regional communities and lead to conflict among sectors of the rural sex industry and between the sex industry and community activists. In addition to examining the problematisation of sex work in rural New South Wales, this paper sets out to understand why rural sex work has historically lacked visibility in popular and scholarly discourses. We provide an overview of the distinctive organisational aspects of the sex industry in rural contexts. Evidence for our assertions is largely derived from primary interview data collected from sex industry workers based in rural New South Wales. The paper represents the first attempt in the research literature on prostitution to understand sex work as a rural phenomenon.