Health Care and the Law [Fifth Edition]

"Fully updated to reflect the rapid pace of change in the health law areas. Explains the legal process as it relates to the health care professional."--Libraries Australia. Table of Contents Part I. Introductory concepts -- 1. What is law -- 2. The legal structure -- 3. The legal process -- Part II. Patient relationships -- 4. Consent to health care by a competent adult -- 5. Consent to health care by a legally incompetent person -- 6. Negligence -- 7. Patient information and privacy -- 8. Patients' property -- 9. Contract -- Part III. Employment -- 10. Contracts to provide health care services -- 011. Accidents and injuries related to health care --12. Registration and practice --13. Drugs --14. Criminal law and health care --15. State involvement in birth and death: registration and coronial inquiries --16. State involvement in threats to health or welfare --17. Human tissue transplants and reproductive technology --18. Expanding recognition of human rights --19. Decision making, law and ethics: a discussion.

Tuning the surface structure of nitrogen-doped TiO2Nanofibres : an effective method to rnhance photocatalytic activities of visible-light-driven green synthesis and degradation

Nitrogen-doped TiO2 nanofibres of anatase and TiO2(B) phases were synthesised by a reaction between titanate nanofibres of a layered structure and gaseous NH3 at 400–700 °C, following a different mechanism than that for the direct nitrogen doping from TiO2. The surface of the N-doped TiO2 nanofibres can be tuned by facial calcination in air to remove the surface-bonded N species, whereas the core remains N doped. N-Doped TiO2 nanofibres, only after calcination in air, became effective photocatalysts for the decomposition of sulforhodamine B under visible-light irradiation. The surface-oxidised surface layer was proven to be very effective for organic molecule adsorption, and the activation of oxygen molecules, whereas the remaining N-doped interior of the fibres strongly absorbed visible light, resulting in the generation of electrons and holes. The N-doped nanofibres were also used as supports of gold nanoparticle (Au NP) photocatalysts for visible-light-driven hydroamination of phenylacetylene with aniline. Phenylacetylene was activated on the N-doped surface of the nanofibres and aniline on the Au NPs. The Au NPs adsorbed on N-doped TiO2(B) nanofibres exhibited much better conversion (80 % of phenylacetylene) than when adsorbed on undoped fibres (46 %) at 40 °C and 95 % of the product is the desired imine. The surface N species can prevent the adsorption of O2 that is unfavourable for the hydroamination reaction, and thus, improve the photocatalytic activity. Removal of the surface N species resulted in a sharp decrease of the photocatalytic activity. These photocatalysts are feasible for practical applications, because they can be easily dispersed into solution and separated from a liquid by filtration, sedimentation or centrifugation due to their fibril morphology.

Improved rural health through a collaborative model of care – qualitative findings

INTRODUCTION Health disparity between urban and rural regions in Australia is well-documented. In the Wheatbelt catchments of Western Australia there is higher incidence and rate of avoidable hospitalisation for chronic diseases. Structured care approach to chronic illnesses is not new but the focus has been on single disease state. A recent ARC Discovery Project on general practice nurse-led chronic disease management of diabetes, hypertension and stable ischaemic heart disease reported improved communication and better medical administration.[1] In our study we investigated the sustainability of such a multi-morbidities general practice –led collaborative model of care in rural Australia. METHODS A QUAN(qual) design was utilised. Eight pairs of rural general practices were matched. Inclusion criteria used were >18 years and capable of giving informed consent, at least one identified risk factor or diagnosed with chronic conditions. Patients were excluded if deemed medically unsuitable. A comprehensive care plan was formulated by the respective general practice nurse in consultation with the treating General Practitioner (GP) and patient based on the individual’s readiness to change, and was informed by available local resource. A case management approach was utilised. Shediaz-Rizkallah and Lee’s conceptual framework on sustainability informed our evaluation.[2] Our primary outcome on measures of sustainability was reduction in avoidable hospitalisation. Secondary outcomes were patients and practitioners acceptance and satisfaction, and changes to pre-determined interim clinical and process outcomes. RESULTS The qualitative interviews highlighted the community preference for a ‘sustainable’ local hospital in addition to general practice. Costs, ease of access, low prioritisation of self chronic care, workforce turnover and perception of losing another local resource if underutilised influenced the respondents’ decision to present at local hospital for avoidable chronic diseases regardless. CONCLUSIONS Despite the pragmatic nature of rural general practice in Australia, the sustainability of chronic multi-morbidities management in general practice require efficient integration of primary-secondary health care and consideration of other social determinants of health. What this study adds: What is already known on this subject: Structured approach to chronic disease management is not new and has been shown to be effective for reducing hospitalisation. However, the focus has been on single disease state. What does this study add: Sustainability of collaborative model of multi-morbidities care require better primary-secondary integration and consideration of social determinants of health.

‘Our’ community : corporate social responsibility, neoliberalisation, and mining industry community engagement in rural Australia

This paper addresses contemporary neoliberal mobilisations of community undertaken by private corporations. It does so by examining the ways in which the mining industry, empowered through the legitimising framework of corporate social responsibility, is increasingly and profoundly involved in shaping the meaning, practice, and experience of ‘local community’. We draw on a substantial Australian case study, consisting of interviews and document analysis, as a means to examine ‘community-engagement’ practices undertaken by BHP Billiton’s Ravensthorpe Nickel Operation in the Shire of Ravensthorpe in rural Australia. This engagement, we argue, as a process of deepening neoliberalisation simultaneously defines and transforms local community according to the logic of global capital. As such, this study has implications for critical understandings of the intersections among corporate social responsibility, neoliberalisation, community, and capital.

How rural criminology informs critical thinking in criminology

Over the past quarter century, a growing volume of rural-focused criminological work has emerged. In this article, the literature related to three rural criminological issues are examined and discussed in terms of their lessons for critical criminology. Research on rural communities and crime is examined as a way to criticize and challenge mainstream criminological theories and concepts like social disorganisation and collective efficacy, and to remind critical criminologists of the importance for developing critical perspectives for place-based or ecological theories of crime. Agricultural crime studies are discussed in terms of the need to develop a critical criminology of agriculture and food. Finally, criminological studies of rural ‘others’ is used to show the need for critical criminologists to give greater analytic attention to divisions and marginalities of peoples living in smaller and more isolated places based on gender, race, and lifestyles, among other factors.

Performance of buried tunnels subjected to surface blast incorporating fluid structure interaction

This paper uses finite element techniques to investigate the performance of buried tunnels subjected to surface blasts incorporating fully coupled Fluid Structure Interaction and appropriate material models which simulate strain rate effects. Modelling techniques are first validated against existing experimental results and then used to treat the blast induced shock wave propagation and tunnel response in dry and saturated sands. Results show that the tunnel buried in saturated sand responds earlier than that in dry sand. Tunnel deformations decrease with distance from explosive in both sands, as expected. In the vicinity of the explosive, the tunnel buried in saturated sand suffered permanent deformation in both axial and circumferential directions, whereas the tunnel buried in dry sand recovered from most of the axial deformation. Overall, response of the tunnel in saturated sand is more severe for a given blast event and shows the detrimental effect of pore water on the blast response of buried tunnels. The validated modelling techniques developed in this paper can be used to investigate the blast response of tunnels buried in dry and saturated sands.

Social networks in arid Australia : a review of concepts and evidence

Arid systems are markedly different from non-arid systems. This distinctiveness extends to arid-social networks, by which we mean social networks which are influenced by the suite of factors driving arid and semi-arid regions. Neither the process of how aridity interacts with social structure, nor what happens as a result of this interaction, is adequately understood. This paper postulates three relative characteristics which make arid-social networks distinct: that they are tightly bound, are hierarchical in structure and, hence, prone to power abuses, and contain a relatively higher proportion of weak links, making them reactive to crisis. These ideas were modified from workshop discussions during 2006. Although they are neither tested nor presented as strong beliefs, they are based on the anecdotal observations of arid-system scientists with many years of experience. This paper does not test the ideas, but rather examines them in the context of five arid-social network case studies with the aim of hypotheses building. Our cases are networks related to pastoralism, Aboriginal outstations, the ‘Far West Coast Aboriginal Enterprise Network’ and natural resources in both the Lake-Eyre basin and the Murray–Darling catchment. Our cases highlight that (1) social networks do not have clear boundaries, and that how participants perceive their network boundaries may differ from what network data imply, (2) although network structures are important determinants of system behaviour, the role of participants as individuals is still pivotal, (3) and while in certain arid cases weak links are engaged in crisis, the exact structure of all weak links in terms of how they place participants in relation to other communities is what matters.

‘I came to this country for a better life’ : factors mediating employment trajectories among young people who migrated to Australia as refugees during adolescence

Located at the intersection of two vulnerable groups in the contemporary labour market, young people who migrate as refugees during adolescence face a unique constellation of opportunities and challenges that shape their employment trajectories. Yet the tendency for research to focus on the early years of refugee settlement means that we have an inadequate understanding the factors that mediate their employment decisions, experiences and outcomes. Based on interviews with 51 young people, this article explores how aspirations, responsibilities, family, education and networks are understood to influence the employment trajectories of adolescent refugee migrants. While this article draws attention to the complex and dynamic range of challenges and constraints that these young people negotiate in the pursuit of satisfying and sustainable employment, what also emerges is an optimistic and determined cohort who, even as they at times unsuccessfully prepare for and navigate the labour market, maintain high hopes for a better life.

How relevant are science curricula for rural and remote students?

This paper reports findings from the Choosing Science study (Lyons & Quinn, 2010) indicating that Australian Year 10 students in small rural or remote areas tend to regard their science lessons as less relevant than do students in larger towns and cities. Specifically, those in small rural or remote schools were significantly more inclined than their city peers to disagree that what they learned in science classes 'helped them make sense of the world'. They were also significantly more likely to strongly agree that they found science lessons boring, and to strongly disagree that science was one of the most interesting subjects. Potential explanations discussed include a mismatch between science curriculum content and the everyday experiences of students in these regions, the relative shortage of experienced specialist science teachers in rural or remote areas and a lack of opportunities to demonstrate the relevance of school science, among others. The paper considers the implications of these findings in relation to the Australian Science Curriculum and whether it is likely to better address the needs of rural and remote students.

Rural high school students' attitudes towards school science

This paper reports findings from an Australian survey of Year 10 students (N=3759) indicating that those in small rural and remote areas tend to enjoy school science significantly less than their peers in larger towns and cities (Lyons & Quinn, 2010). The study also found that rural and remote students were less inclined than those in other locations to enjoy science relative to other subjects. Such a result has not previously been recorded in the science education literature and raises a number of questions about the relevance and quality of the science education experienced by rural and remote students. It also raises timely questions about the applicability to rural and remote students of an Australian Science Curriculum. The paper explores these issues and their implications for policy and research.

Innovation for Equity in Rural Education : Proceedings of the International Symposium for Innovation in Rural Education

PREFACE The concept of an international symposium on rural education arose from a meeting between members of the SiMERR National Centre, Australia and the NURI Teacher Education Innovation Centre (NURI-TEIC) at Kongju National University, Korea in 2007. Despite the very different national contexts, the teams were struck by the similarities of the challenges facing rural schools in the two countries, and curious about the degree to which these challenges were shared by other countries. At a subsequent meeting in Australia in December 2007, the two centre Directors - Professor John Pegg (SiMERR) and Professor Youn-Kee Im (NURI-TEIC) - agreed on a framework for the first International Symposium for Innovation in Rural Education (ISFIRE). This volume consists of the keynotes and refereed papers presented at ISFIRE 2009. The papers provide insights into rural education in Australia, Bhutan, Canada, Korea, Norway, South Africa and the United States along the following themes: 1. Promoting rural policy initiatives; 2. Nurturing the rural teacher experience; 3. Enhancing rural student experience and growth; 4. Optimising the curriculum; 5. Improving resources in rural schools; and 6. Addressing special issues in rural education. The authors and titles of a further 23 presentations based on refereed abstracts only are listed at the end of this volume. The abstracts for these presentations can be found in the symposium Program. The academics and practitioners who came together for this symposium are passionate about rural education and have dedicated their time and capacities to working for the benefit of rural teachers, students and communities. The papers in this volume offer direction not only for Australia and South Korea, who jointly hosted this symposium, but for all countries in which rural education is contested ground. The keynotes in particular contribute rich perspectives on rural education trends, policies and practices. We hope that this volume generates a greater appreciation of the advantages of rural education and the many innovative approaches being implemented to meet its challenges.

Teachers' motivations for working in rural schools

This paper reports on the analysis of qualitative and quantitative data concerning Australian teachers’ motivations for taking up, remaining in, or leaving teaching positions in rural and regional schools. The data were collected from teachers (n = 2940) as part of the SiMERR National Survey, though the results of the qualitative data analysis were not published with the survey report in 2006. The teachers’ comments provide additional insight into their career decisions, complementing the quantitative findings. Content and frequency analyses of the teachers’ comments reveal individual and collective priorities which together with the statistical evidence can be used to inform policies aimed at addressing the staffing needs of rural schools.

Rural people and the land

There is a long and fundamental connection between rural place and the land. Whereas land is simply the foundation for the construction of towns and cities, whose urban culture and economy thrives on human ingenuity and industry that may have little direct attachment to the physical ground over which it occurs, historical discourses of rurality place the land at the heart of the rural economy and society. Rural people, such discourses hold, live on the land, work the land, tend the land and know the land. The land formed not only the base of the rural economy (as ‘a physical, tangible resource which can be ploughed, sown, grazed, built upon’ (Macnaghten and Urry 1998, 200)), but also shaped rural culture and the rural calendar, and contributed to the constitution of the rural character (see Bell 1994). As such, the land is central to rural sense of place.

The Implications of Activity Based Funding for Emergency Departments : A Comprehensive Literature Review

Executive Summary Emergency Departments (EDs) locally, nationally and internationally are becoming increasingly busy. Within this context, it can be challenging to deliver a health service that is safe, of high quality and cost-effective. Whilst various models are described within the literature that aim to measure ED ‘work’ or ‘activity’, they are often not linked to a measure of costs to provide such activity. It is important for hospital and ED managers to understand and apply this link so that optimal staffing and financial resourcing can be justifiably sought. This research is timely given that Australia has moved towards a national Activity Based Funding (ABF) model for ED activity. ABF is believed to increase transparency of care and fairness (i.e. equal work receives equal pay). ABF involves a person-, performance- or activity-based payment system, and thus a move away from historical “block payment” models that do not incentivise efficiency and quality. The aim of the Statewide Workforce and Activity-Based Funding Modelling Project in Queensland Emergency Departments (SWAMPED) is to identify and describe best practice Emergency Department (ED) workforce models within the current context of ED funding that operates under an ABF model. The study is comprised of five distinct phases. This monograph (Phase 1) comprises a systematic review of the literature that was completed in June 2013. The remaining phases include a detailed survey of Queensland hospital EDs’ resource levels, activity and operational models of care, development of new resource models, development of a user-friendly modelling interface for ED mangers, and production of a final report that identifies policy implications. The anticipated deliverable outcome of this research is the development of an ABF based Emergency Workforce Modelling Tool that will enable ED managers to profile both their workforce and operational models of care. Additionally, the tool will assist with the ability to more accurately inform adequate staffing numbers required in the future, inform planning of expected expenditures and be used for standardisation and benchmarking across similar EDs. Summary of the Findings Within the remit of this review of the literature, the main findings include: 1. EDs are becoming busier and more congested Rising demand, barriers to ED throughput and transitions of care all contribute to ED congestion. In addition requests by organisational managers and the community require continued broadening of the scope of services required of the ED and further increases in demand. As the population live longer with more lifestyle diseases their propensity to require ED care continues to grow. 2. Various models of care within EDs exist Models often vary to account for site specific characteritics to suit staffing profile, ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Existing and new models implemented within EDs often depend on the target outcome requiring change. Generally this is focussed on addressing issues at the input, throughput or output areas of the ED. Even with models targeting similar demographic or illness, the structure and process elements underpinning the model can vary, which can impact on outcomes and variance to the patient and carer experience between and within EDs. Major models of care to manage throughput inefficiencies include: A. Workforce Models of Care focus on the appropriate level of staffing for a given workload to provide prompt, timely and clinically effective patient care within an emergency care setting. The studies reviewed suggest that the early involvement of senior medical decision maker and/or specialised nursing roles such as Emergency Nurse Practitioners and Clinical Initiatives Nurse, primary contact or extended scope Allied Health Practitioners can facilitate patient flow and improve key indicators such as length of stay and reducing the number of those who did not wait to be seen amongst others. B. Operational Models of Care within EDs focus on mechanisms for streaming (e.g. fast-tracking) or otherwise grouping patient care based on acuity and complexity to assist with minimising any throughput inefficiencies. While studies support the positive impact of these models in general, it appears that they are most effective when they are adequately resourced. 3. Various methods of measuring ED activity exist Measuring ED activity requires careful consideration of models of care and staffing profile. Measuring activity requires the ability to account for factors including: patient census, acuity, LOS, intensity of intervention, department skill-mix plus an adjustment for non-patient care time. 4. Gaps in the literature Continued ED growth calls for new and innovative care delivery models that are safe, clinically effective and cost effective. New roles and stand-alone service delivery models are often evaluated in isolation without considering the global and economic impact on staffing profiles. Whilst various models of accounting for and measuring health care activity exist, costing studies and cost effectiveness studies are lacking for EDs making accurate and reliable assessments of care models difficult. There is a necessity to further understand, refine and account for measures of ED complexity that define a workload upon which resources and appropriate staffing determinations can be made into the future. There is also a need for continued monitoring and comprehensive evaluation of newly implemented workforce modelling tools. This research acknowledges those gaps and aims to: • Undertake a comprehensive and integrated whole of department workforce profiling exercise relative to resources in the context of ABF. • Inform workforce requirements based on traditional quantitative markers (e.g. volume and acuity) combined with qualitative elements of ED models of care; • Develop a comprehensive and validated workforce calculation tool that can be used to better inform or at least guide workforce requirements in a more transparent manner.