The core role of the nurse practitioner: practice, professionalism and clinical leadership.

AIM: To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. BACKGROUND: Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally. METHOD: This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data. FINDINGS: The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care. CONCLUSION: A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide new perspectives to inform the international debate about this extended level of nursing practice. RELEVANCE TO CLINICAL PRACTICE: The findings from this research have the potential to achieve a standardised approach and internationally consistent nomenclature for the nurse practitioner role.

Novel car carrier design : prevention of falls from heights

This article reports the details of a research on novel design in the field of semitrailer sector and discuss design by hazard prevention techniques. The novel design made addresses occupational health and safety (OHS)concerns of fall from heights. The research includes a detailed survey of national data sources to examine the fatalities caused due to fall from heights in car carriers. The study investigates OHS recommendations in Australia for semitrailer sector. Often injuries are caused due to drivers working above the 1.5 meter height for loading, unloading of the cars, moving the decks up, down, strapping the cars, and slipperly. The new design is developed using latest computer aided design and engineeing (CAD, CAE), product data management (PDM), virtual design process (VDP). The new car carrier design excels in reducing the risks of injuries to drivers and new bench mark for OHS standards. The new design has all the decks operated with hydraulics and uses unique ratchet lock mechanism (fool proof design) and loading happens at a safe working height (below 1.5 meter). All the cars are strapped on the safe working height, and then car desks operated hydraulically to transfer them to the required position. This also includes the car on the prime mover, which shuttles across from one deck to other using hydraulic and rack-pinion mechanisms. The novel design car carrier solves the problem of falls from height: next step would be to transfer this technology across other similar effected sectors.

Managing illegal street racing and associated risky driving behaviour : An Australian perspective

Illegal street racing has received increased attention in recent years from the media, governments and road safety professionals. At the same time, there has been a shift from treating illegal street racing as a public nuisance issue to a road safety problem in Australia, as this behaviour now attracts a penalty of increased periods of vehicle impoundment leading to permanent vehicle forfeiture for repeat offences. This severe vehicle sanction is typically applied to repeat drink driving offenders and drivers who breach suspensions and disqualifications in North American jurisdictions, but was first introduced in Australia to deal with illegal street racing and associated risky driving behaviours, grouped together under the label of ‘hooning’ in Australian jurisdictions. This paper describes how Australian jurisdictions are dealing with this issue. The research described in this paper drew on multiple data sources to explore illegal street racing and the management of this issue in Australia. First, the paper reviews the relevant legislation in each Australian state to describe the cross-jurisdictional similarities and differences in approaches. It also describes some results from focus group discussions and a quantitative online survey with drivers who self-report engaging in illegal street racing and associated behaviours in Queensland, Australia. It was found that approaches to dealing with illegal street racing and associated risky driving behaviours in each Australian state are similar, with increasing periods of vehicle impoundment (leading to vehicle forfeiture) applied to repeat hooning offences within prescribed periods. Participants in the focus groups and respondents to the questionnaire generally felt these penalty periods were severe, with perceptions of severity increasing with the length of the penalty period. It was concluded that there is a need for each jurisdiction to objectively evaluate the effectiveness of their vehicle impoundment and forfeiture programs for hooning. These evaluations should compare the relative costs of these programs (e.g., enforcement, unrecovered towing and storage fees, and court costs) to the observed benefits (e.g., reduction in target behaviours, reduction in community complaints, and reduction in the number and severity of associated crashes).

Privacy and trust management for electronic health records

Establishing a nationwide Electronic Health Record system has become a primary objective for many countries around the world, including Australia, in order to improve the quality of healthcare while at the same time decreasing its cost. Doing so will require federating the large number of patient data repositories currently in use throughout the country. However, implementation of EHR systems is being hindered by several obstacles, among them concerns about data privacy and trustworthiness. Current IT solutions fail to satisfy patients’ privacy desires and do not provide a trustworthiness measure for medical data. This thesis starts with the observation that existing EHR system proposals suer from six serious shortcomings that aect patients’ privacy and safety, and medical practitioners’ trust in EHR data: accuracy and privacy concerns over linking patients’ existing medical records; the inability of patients to have control over who accesses their private data; the inability to protect against inferences about patients’ sensitive data; the lack of a mechanism for evaluating the trustworthiness of medical data; and the failure of current healthcare workflow processes to capture and enforce patient’s privacy desires. Following an action research method, this thesis addresses the above shortcomings by firstly proposing an architecture for linking electronic medical records in an accurate and private way where patients are given control over what information can be revealed about them. This is accomplished by extending the structure and protocols introduced in federated identity management to link a patient’s EHR to his existing medical records by using pseudonym identifiers. Secondly, a privacy-aware access control model is developed to satisfy patients’ privacy requirements. The model is developed by integrating three standard access control models in a way that gives patients access control over their private data and ensures that legitimate uses of EHRs are not hindered. Thirdly, a probabilistic approach for detecting and restricting inference channels resulting from publicly-available medical data is developed to guard against indirect accesses to a patient’s private data. This approach is based upon a Bayesian network and the causal probabilistic relations that exist between medical data fields. The resulting definitions and algorithms show how an inference channel can be detected and restricted to satisfy patients’ expressed privacy goals. Fourthly, a medical data trustworthiness assessment model is developed to evaluate the quality of medical data by assessing the trustworthiness of its sources (e.g. a healthcare provider or medical practitioner). In this model, Beta and Dirichlet reputation systems are used to collect reputation scores about medical data sources and these are used to compute the trustworthiness of medical data via subjective logic. Finally, an extension is made to healthcare workflow management processes to capture and enforce patients’ privacy policies. This is accomplished by developing a conceptual model that introduces new workflow notions to make the workflow management system aware of a patient’s privacy requirements. These extensions are then implemented in the YAWL workflow management system.

The impact of tax morale and institutional quality on the shadow economy

This paper uses a multivariate analysis to examine how countries‘ tax morale and institutional quality affect the shadow economy. The literature strongly emphasizes the quantitative importance of these factors in understanding the level of and changes in the shadow economy. Newly available data sources offer the unique opportunity to further illuminate a topic that has received increased attention. After controlling for a variety of potential factors, we find strong support that a higher tax morale and a higher institutional quality lead to a smaller shadow economy.

Client recommendations for financial incentives on construction projects

Purpose: To provide recommendations for construction clients who design and implement financial incentive mechanisms (FIMs) on projects. ---------- Methodology: Four large Australian building projects commissioned by government clients under managing contractor contracts and completed between 2001 and 2005 were examined to explore the ‘drivers’ that promoted motivation toward financial incentive goals. The results were triangulated across data sources, projects and stakeholder types. ---------- Findings: FIM design should incorporate: 1. flexibility to modify goals and measurement procedures over time, 2. multiple goals covering different project areas, 3. distribution of rewards across all the key organizations contributing to team performance (e.g. potentially not just the contractor, but the subcontractors and consultants) and a reward amount sufficient to be valued by potential recipients. FIM benefits are maximized through the following complementary procurement initiatives: 4. equitable contract risk allocation, 5. early contractor involvement in design, 6. value-driven tender selection, 7. relationship workshops, and 8. future work opportunities.---------- Research Limitations: This paper provides practical recommendations to industry and hence does not emphasize theoretical aspects.---------- Practical Implications: The uptake of these recommendations is likely to increase the impact of FIMs on motivation and improve project and industry outcomes. Although the study focuses on government clients of building projects, all the recommendations would seem to apply equally to private-sector clients and to non-building projects.---------- Originality: In order to improve motivation and reward high performance, clients are increasingly using FIM in their construction contracts. Despite the rising use of financial incentives, there is a lack of comprehensive construction-specific knowledge available to help clients maximize outcomes. The study addresses this gap in the literature.

Settlement geography of African refugee communities in Southeast Queensland : an analysis of residential distribution and secondary migration

Before 2001, most Africans immigrating to Australia were white South Africans and Zimbabweans who arrived as economic and family-reunion migrants (Cox, Cooper & Adepoju, 1999). Black African communities are a more recent addition to the Australian landscape, with most entering Australia as refugees after 2001. African refugees are a particularly disadvantaged immigrant group, which the Department of Immigration and Multicultural Affairs (in the Community Relations Commission of New South Wales, 2006) suggests require high levels of settlement support (p.23). Decision makers and settlement service providers need to have settlement data on the communities so that they can be effective in planning, budgeting and delivering support where it is most needed. Settlement data are also useful for determining the challenges that these communities face in trying to establish themselves in resettlement. There has been no verification of existing secondary data sources, however, or previous formal study of African refugee settlement geography in Southeast Queensland. This research addresses the knowledge gap by using a mixed-method approach to identify and describe the distribution and population size of eight African communities in Southeast Queensland, examine secondary migration patterns in these communities and assess the relationship between these geographic features and housing, a critical factor in successful settlement. Significant discrepancies exist between the primary data gathered in the study and existing secondary data relating to population size and distribution of the communities. Results also reveal a tension between the socio-cultural forces and the housing and economic imperatives driving secondary migration in the communities, and a general lack of engagement by African refugees with structured support networks. These findings have a wide range of implications for policy and for groups that provide settlement support to these communities.

The Guardian Reportage of the UK MP Expenses Scandal: a Case Study of Computational Journalism

The Guardian reportage of the United Kingdom Member of Parliament (MP) expenses scandal of 2009 used crowdsourcing and computational journalism techniques. Computational journalism can be broadly defined as the application of computer science techniques to the activities of journalism. Its foundation lies in computer assisted reporting techniques and its importance is increasing due to the: (a) increasing availability of large scale government datasets for scrutiny; (b) declining cost, increasing power and ease of use of data mining and filtering software; and Web 2.0; and (c) explosion of online public engagement and opinion.. This paper provides a case study of the Guardian MP expenses scandal reportage and reveals some key challenges and opportunities for digital journalism. It finds journalists may increasingly take an active role in understanding, interpreting, verifying and reporting clues or conclusions that arise from the interrogations of datasets (computational journalism). Secondly a distinction should be made between information reportage and computational journalism in the digital realm, just as a distinction might be made between citizen reporting and citizen journalism. Thirdly, an opportunity exists for online news providers to take a ‘curatorial’ role, selecting and making easily available the best data sources for readers to use (information reportage). These activities have always been fundamental to journalism, however the way in which they are undertaken may change. Findings from this paper may suggest opportunities and challenges for the implementation of computational journalism techniques in practice by digital Australian media providers, and further areas of research.

Interventions for preventing and managing aggressive patients admitted to an acute hospital setting: A systematic review

Background: Violence in health care has been widely reported and health care workers, particularly nurses in acute care settings, are ill-equipped to manage patients who exhibit aggressive traits. Aim: The aim of this systematic review was to establish best practice in the prevention and management of aggressive behaviours in patients admitted to acute hospital settings. Data Sources: An extensive search of the major databases was conducted from 1990 to 2007. The search included published and unpublished studies and papers in English. Review Methods: This review considered any quantitative research study design that evaluated the effectiveness of interventions in the prevention and management of patients who exhibit aggressive behaviours in an acute hospital setting. Each included study was quality assessed by two independent reviewers and data were extracted using the relevant tools developed by the Joanna Briggs Institute. Results: Ten studies met the inclusion criteria and were included in the review. The evidence identified from the studies includes: the benefit of education and training of acute care nurses in aggression management techniques; use of “as required” medications is effective in minimising harm to patients and staff; and that specific interventions such as physical restraint may play a role in managing aggressive behaviours from patients in the acute care setting. Conclusions: This review makes several recommendations for the prevention and management of aggressive behaviours in acute hospital patients. However, due to the lack of high-quality studies conducted in the acute care setting there is huge scope for future research in this area.

Information transfer for multi-trauma patients on discharge from the emergency department : mixed-method narrative review

Aim. This paper is a report of a review conducted to identify (a) best practice in information transfer from the emergency department for multi-trauma patients; (b) conduits and barriers to information transfer in trauma care and related settings; and (c) interventions that have an impact on information communication at handover and beyond. Background. Information transfer is integral to effective trauma care, and communication breakdown results in important challenges to this. However, evidence of adequacy of structures and processes to ensure transfer of patient information through the acute phase of trauma care is limited. Data sources. Papers were sourced from a search of 12 online databases and scanning references from relevant papers for 1990–2009. Review methods. The review was conducted according to the University of York’s Centre for Reviews and Dissemination guidelines. Studies were included if they concerned issues that influenced information transfer for patients in healthcare settings. Results. Forty-five research papers, four literature reviews and one policy statement were found to be relevant to parts of the topic, but not all of it. The main issues emerging concerned the impact of communication breakdown in some form, and included communication issues within trauma team processes, lack of structure and clarity during handovers including missing, irrelevant and inaccurate information, distractions and poorly documented care. Conclusion. Many factors influence information transfer but are poorly identified in relation to trauma care. The measurement of information transfer, which is integral to patient handover, has not been the focus of research to date. Nonetheless, documented patient information is considered evidence of care and a resource that affects continuing care.

The Guardian reportage of the UK MP expenses scandal: a case study of computational journalism

The Guardian reportage of the United Kingdom Member of Parliament (MP) expenses scandal of 2009 used crowdsourcing and computational journalism techniques. Computational journalism can be broadly defined as the application of computer science techniques to the activities of journalism. Its foundation lies in computer assisted reporting techniques and its importance is increasing due to the: (a) increasing availability of large scale government datasets for scrutiny; (b) declining cost, increasing power and ease of use of data mining and filtering software; and Web 2.0; and (c) explosion of online public engagement and opinion.. This paper provides a case study of the Guardian MP expenses scandal reportage and reveals some key challenges and opportunities for digital journalism. It finds journalists may increasingly take an active role in understanding, interpreting, verifying and reporting clues or conclusions that arise from the interrogations of datasets (computational journalism). Secondly a distinction should be made between information reportage and computational journalism in the digital realm, just as a distinction might be made between citizen reporting and citizen journalism. Thirdly, an opportunity exists for online news providers to take a ‘curatorial’ role, selecting and making easily available the best data sources for readers to use (information reportage). These activities have always been fundamental to journalism, however the way in which they are undertaken may change. Findings from this paper may suggest opportunities and challenges for the implementation of computational journalism techniques in practice by digital Australian media providers, and further areas of research.

Which components of heart failure programs are effective? A meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of heart failure management in 9,560 patients (Abridged Cochrane Review)

Aims--Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialised management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. Objectives To review randomised controlled trials (RCTs) of TM or STS on all- cause mortality and all-cause and CHF-related hospitalisations in patients with CHF, as a non-invasive remote model of specialised disease-management intervention.--Methods and Results--Data sources:We searched 15 electronic databases and hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Study eligibility and participants: We included any randomised controlled trials (RCT) comparing TM or STS to usual care of patients with CHF. Studies that included intensified management with additional home or clinic visits were excluded. Synthesis: Primary outcomes (mortality and hospitalisations) were analysed; secondary outcomes (cost, length of stay, quality of life) were tabulated.--Results: Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n=8,323) and five abstracts (n=1,482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2,710 participants), 16 evaluated STS (5,613 participants) and two tested both interventions. TM reduced all-cause mortality (risk ratio (RR 0•66 [95% CI 0•54-0•81], p<0•0001) and STS showed similar trends (RR 0•88 [95% CI 0•76-1•01], p=0•08). Both TM (RR 0•79 [95% CI 0•67-0•94], p=0•008) and STS (RR 0•77 [95% CI 0•68-0•87], p<0•0001) reduced CHF-related hospitalisations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed.--Conclusion: TM and STS both appear effective interventions to improve outcomes in patients with CHF.

Risky driving or risky drivers? Exploring driving and crash histories of illegal street racing offenders

Illegal street racing has received increased attention in recent years from road safety professionals and the media as jurisdictions in Australia, Canada, and the United States have implemented laws to address the problem, which primarily involves young male drivers. Although some evidence suggests that the prevalence of illegal street racing is increasing, obtaining accurate estimates of the crash risk of this behavior is difficult because of limitations in official data sources. Although crash risk can be explored by examining the proportion of incidents of street racing that result in crashes, or the proportion of all crashes that involve street racing, this paper reports on the findings of a study that explored the riskiness of involved drivers. The driving histories of 183 male drivers with an illegal street racing conviction in Queensland, Australia, were compared with a random sample of 183 male Queensland drivers with the same age distribution. The offender group was found to have significantly more traffic infringements, license sanctions, and crashes than the comparison group. Drivers in the offender group were more likely than the comparison group to have committed infringements related to street racing, such as speeding, "hooning," and offenses related to vehicle defects or illegal modifications. Insufficient statistical capacity prevented full exploration of group differences in the type and nature of earlier crashes. It was concluded, however, that street racing offenders generally can be considered risky drivers who warrant attention and whose risky behavior cannot be explained by their youth alone.

Risk taking in Extreme Sports: A phenomenological perspective

Participation in extreme sports is enjoying incredible growth while more traditional recreational activities such as golf are struggling to maintain numbers. Theoretical perspectives on extreme sports and extreme sport participants have assumed that participation is about risk-taking. However, these theory-driven methodologies may reflect judgments that do not necessarily relate to participants' lived experience. In this paper I review current risk-oriented perspectives on extreme sports and present research findings that question this assumed relationship between extreme sports and risk and thus reposition the experience in a hitherto unexplored manner. Risk taking is not the focus. Participants acknowledge that the potential outcome of a mismanaged mistake or accident could be death. However, accepting this potential outcome does not mean that they search for risk. Participants argue that many everyday life events (e.g., driving) are high-risk events. Participants undertake detailed preparation in order to minimise the possibility of negative outcomes because extreme sports trigger a range of positive experiential outcomes. The study is significant as it followed a hermeneutic phenomenological process which did not presuppose a risk-taking orientation. Hermeneutic phenomenology allows for a multitude of data sources including interviews (10 male and 5 female extreme sports participants, ages 30 to 72 years), auto-biographies, videos and other firsthand accounts. This process allowed this unexpected perspective to emerge more clearly.

Enhancing research productivity of TEFL academics in China

As research has become an important indicator of TEFL academics’ overall performance in Chinese higher education institutions, it is critical that TEFL academics are able to meet the expectation of conducting research. This mixedmethod study investigated research productivity of Chinese TEFL academics and associated influences, with the ultimate objective of constructing a framework to help build their research capacity in the future. Using an initial survey, the study provided a snapshot of research productivity of 182 TEFL academics from three Chinese higher education institutions, and individual and institutional characteristics that influenced their research productivity. Using interviews and documents as the data sources, the subsequent qualitative case study of two purposively-sampled Chinese TEFL departments provided insights into Chinese TEFL academics’ perceptions about research, and individual, institutional and departmental efforts in meeting the research expectation. The findings from this study revealed that the 182 Chinese TEFL academics’ research productivity during 2004-2008 was relatively low as a whole as was the quality of their research. This study identified four influences that impacted on Chinese TEFL academics’ research productivity: TEFL disciplinary influences, institutional and departmental research environments, individual characteristics desirable for research, and TEFL academics’ perceptions about research. Drawing upon the above findings from this study, a Framework towards Enhancing Chinese TEFL Academics’ Research Productivity (FECTARP) was constructed. The FECTARP synthesised the findings from the study, and presented a framework for Chinese institutions and TEFL departments to enhance their TEFL academics’ research capacity.