Haemodialysis work environment contributors to job satisfaction and stress: A sequential mixed methods study

Background: Haemodialysis nurses form long term relationships with patients in a technologically complex work environment. Previous studies have highlighted that haemodialysis nurses face stressors related to the nature of their work and also their work environments leading to reported high levels of burnout. Using Kanters (1997) Structural Empowerment Theory as a guiding framework, the aim of this study was to explore the factors contributing to satisfaction with the work environment, job satisfaction, job stress and burnout in haemodialysis nurses. Methods: Using a sequential mixed-methods design, the first phase involved an on-line survey comprising demographic and work characteristics, Brisbane Practice Environment Measure (B-PEM), Index of Work Satisfaction(IWS), Nursing Stress Scale (NSS) and the Maslach Burnout Inventory (MBI). The second phase involved conducting eight semi-structured interviews with data thematically analyzed. Results: From the 417 nurses surveyed the majority were female (90.9 %), aged over 41 years of age (74.3 %), and 47.4 % had worked in haemodialysis for more than 10 years. Overall the work environment was perceived positively and there was a moderate level of job satisfaction. However levels of stress and emotional exhaustion (burnout) were high. Two themes, ability to care and feeling successful as a nurse, provided clarity to the level of job satisfaction found in phase 1. While two further themes, patients as quasi-family and intense working teams, explained why working as a haemodialysis nurse was both satisfying and stressful. Conclusions: Nurse managers can use these results to identify issues being experienced by haemodialysis nurses working in the unit they are supervising.

Transformative times: Australian journalists’ perceptions of changes in their work

Numerous studies have pointed to the fact that journalism in most industrialised societies is undergoing a particularly intensive period of transformation. Yet, while many scholars have studied how news organisations are changing, comparatively fewer studies have inquired into how journalists themselves are experiencing the changes in their work brought on by the technological, economic and cultural transformations. Based on a representative study of Australian journalists, this paper reports on their perceptions of changes in a variety of influences and aspects of their work over the past five years. It finds that journalists say change has been most notable in audience interactions and technological innovation, while economic changes are somewhat less strong. Importantly, they are also very concerned about an increase in sensationalism and a drop in journalistic standards and the credibility of journalism. Results are also compared across different organisational contexts.

'How much love are you going to give this brand?' Lifestyle journalists on commercial influences in their work

The news increasingly provides help, advice, guidance, and information about the management of self and everyday life, in addition to its traditional role in political communication. Yet such forms of journalism are still regularly denigrated in scholarly discussions, as they often deviate from normative ideals. This is particularly true in lifestyle journalism, where few studies have examined the impact of commercial influences. Through in-depth interviews with 89 Australian and German lifestyle journalists, this paper explores the ways in which journalists experience how the lifestyle industries try to shape their daily work, and how these journalists deal with these influences. We find that lifestyle journalists are in a constant struggle over the control of editorial content, and their responses to increasing commercial pressures vary between resistance and resignation. This has implications for our understanding of journalism as a whole in that it broadens it beyond traditional conceptualizations associated with political journalism.

'Work it out': Evaluation of a chronic condition self-management program for urban Aboriginal and Torres Strait Islander people with or at risk of cardiovascular disease

This thesis evaluates a chronic condition self-management program for Aboriginal and Torres Strait Islander people in urban south-east Queensland who have or are at risk of cardiovascular disease. Outcomes showed short-term improvements for some anthropometry measures which could be a trend for improvement in other anthropometry indicators over the longer term. The program was of particular benefit for participants who had several social and emotional wellbeing conditions. The use of an Aboriginal and Torres Strait Islander conceptual framework was critical in undertaking culturally competent quantitative research in this project.

Use of electronic portal imaging devices for electron treatment verification

This study aims to help broaden the use of electronic portal imaging devices (EPIDs) for pre-treatment patient positioning verification, from photon-beam radiotherapy to photon- and electron-beam radiotherapy, by proposing and testing a method for acquiring clinicallyuseful EPID images of patient anatomy using electron beams, with a view to enabling and encouraging further research in this area. EPID images used in this study were acquired using all available beams from a linac configured to deliver electron beams with nominal energies of 6, 9, 12, 16 and 20 MeV, as well as photon beams with nominal energies of 6 and 10 MV. A widely-available heterogeneous, approximately-humanoid, thorax phantom was used, to provide an indication of the contrast and noise produced when imaging different types of tissue with comparatively realistic thicknesses. The acquired images were automatically calibrated, corrected for the effects of variations in the sensitivity of individual photodiodes, using a flood field image. For electron beam imaging, flood field EPID calibration images were acquired with and without the placement of blocks of water-equivalent plastic (with thicknesses approximately equal to the practical range of electrons in the plastic) placed upstream of the EPID, to filter out the primary electron beam, leaving only the bremsstrahlung photon signal. While the electron beam images acquired using a standard (unfiltered) flood field calibration were observed to be noisy and difficult to interpret, the electron beam images acquired using the filtered flood field calibration showed tissues and bony anatomy with levels of contrast and noise that were similar to the contrast and noise levels seen in the clinically acceptable photon beam EPID images. The best electron beam imaging results (highest contrast, signal-to-noise and contrast-to-noise ratios) were achieved when the images were acquired using the higher energy electron beams (16 and 20 MeV) when the EPID was calibrated using an intermediate (12 MeV) electron beam energy. These results demonstrate the feasibility of acquiring clinically-useful EPID images of patient anatomy using electron beams and suggest important avenues for future investigation, thus enabling and encouraging further research in this area. There is manifest potential for the EPID imaging method proposed in this work to lead to the clinical use of electron beam imaging for geometric verification of electron treatments in the future.

Multidisciplinary review of teaching and assessing competency attainment by non-medical prescribers

Background Prescribing is a complex task, requiring specific knowledge and skills, and the execution of effective, context-specific clinical reasoning. Systematic reviews indicate medical prescribing errors have a median rate of 7% [IQR 2%-14%] of medication orders [1-3]. For podiatrists pursuing prescribing rights, a clear need exists to ensure practitioners develop a well-defined set of prescribing skills, which will contribute to competent, safe and appropriate practice. Aim To investigate the methods employed to teach and assess the principles of effective prescribing in the undergraduate podiatry program and compare and contrast these findings with four other non-medical professions who undertake prescribing after training at Queensland University of Technology. Method The NPS National Prescribing Competency Standards were employed as the prescribing standard. A curriculum mapping exercise was undertaken to determine whether the prescribing principles articulated in the competency standards were addressed by each profession. Results A range of methods are currently utilised to teach prescribing across disciplines. Application of prescribing competencies to the context of each profession appears to influence the teaching methods used. Most competencies were taught using a multimodal format, including interactive lectures, self-directed learning, tutorial sessions and clinical placement. In particular clinical training was identified as the most consistent form of educating safe prescribers across all five disciplines. Assessment of prescribing competency utilised multiple techniques including written and oral examinations and research tasks, case studies, objective structured clinical examination exercises and the assessment of clinical practice. Effective and reliable assessment of prescribing undertaken by students in diverse settings remains challenging e.g. that occurring in the clinical practice environment. Conclusion Recommendations were made to refine curricula and to promote efficient cross-discipline teaching by staff from the disciplines of podiatry, pharmacy, nurse practitioner, optometry and paramedic science. Students now experience a sophisticated level of multidisciplinary learning in the clinical setting which integrates the expertise and skills of experience prescribers combined with innovative information technology platforms (CCTV and live patient assessments). Further work is required to establish a practical, effective approach to the assessment of prescribing competence especially between the university and clinical settings.

“We have to work within the system!”: Staff perceptions of organizational barriers to decision making for older adults with dementia in Australian aged care facilities

The current study explored the perceptions of direct care staff working in Australian residential aged care facilities (RACFs) regarding the organizational barriers that they believe prevent them from facilitating decision making for individuals with dementia. Normalization process theory (NPT) was used to interpret the findings to understand these barriers in a broader context. The qualitative study involved semi-structured interviews (N = 41) and focus groups (N = 8) with 80 direct care staff members of all levels working in Australian RACFs. Data collection and analysis were conducted in parallel and followed a systematic, inductive approach in line with grounded theory. The perceptions of participants regarding the organizational barriers to facilitating decision making for individuals with dementia can be described by the core category, Working Within the System, and three sub-themes: (a) finding time, (b) competing rights, and (c)not knowing. Examining the views of direct care staff through the lens of NPT allows possible areas for improvement to be identified at an organizational level and the perceived barriers to be understood in the context of promoting normalization of decision making for individuals with dementia.

How Jung's concept of the wounded healer can guide learning and teaching in social work and human services

The concept of the “wounded healer” has been used to explain why those with adverse childhood histories often enter helping professions such as social work and human services (SWHS). Psychotherapist Carl Jung (1875–1961) believed wounded healers developed insight and resilience from their own experiences, enabling transformative interventions to occur with clients. Concerns exist that students with adverse childhood histories in SWHS may display unresolved emotional issues. This journal article explores how Jung’s interpretation of the wounded healer can be critically applied to understanding the learning needs of SWHS students with histories of abuse, neglect or other childhood adversity. The relevance of the wounded healer to SWHS education is explored in three key areas: - 1) the increased possibility of the occurrence of countertransference; - 2) the potential for vicarious traumatisation and burnout, and; - 3) personal and professional resilience displayed by SWHS students with a history of childhood adversity. The wounded healer metaphor allows for a more nuanced understanding of SWHS students with these histories. It also provides insight into the pedagogical considerations associated with teaching this student cohort.

Major practicum as a learning site for exercise science professionals: A pilot study

Exercise science is now an integral part of the allied health framework in Australia and graduates from accredited programmes are equipped with skills recognised as being important in the prevention and management of lifestyle-related diseases. This pilot study sought to determine the experiences of 11 final-year exercise science students in their major practicum and identify skills learned and developed while on placement. Analysis of the interview data established that the students worked with clients from a broad range of sociocultural and socioeconomic backgrounds, both within and between practicum sites; the students’ experiences and their preparedness to engage with clients from different backgrounds varied as a result. Although the students generally reported being technically skilled for their major placement, many reported being underprepared to deal with people from different backgrounds. However, all participants held that their interpersonal skills greatly improved in response to their placement and several remarked that they developed their problem-solving skills through watching and assisting their supervisors work with clients. The present study confirms the practicum as a critical learning site for improving communication and problem-solving skills with exercise science and exercise physiology students.

Indigenous legal education at UNSW: A work in progress

Since the 1970s Australian law schools have provided alternative entry routes and, since the 1980s, pre-law programs and bridging programs. On-going support, once Indigenous students reach university law schools, has been an issue that has not been formally or appropriately addressed in most university law schools. In this way Indigenous students’ chances of entry are disguised as chances of success. Thus once Indigenous students start their law school studies, they are often expected to perform on a level playing field – their success or failure then depends on ‘gifts, merits or skills’ which are culturally appropriate for law school. This attitude fails to recognise the privilege which allows the development of such gifts, merits or skills...

'The ones with the beastly lives': Gender and textuality in Jean Rhys's Voyage in the Dark

Anna Morgan, the central character of Jean Rhys's Voyage in the Dark, has previously been read as a victim of her own inability to fashion some form of life for herself.1 It is possible, however, to suggest an alternative to such character-based readings and instead examine the systems of oppression which work to ensure that Anna remains an excluded, marginalized subject. Rather than personal failings, it is Anna's gender and colonial status which prevent her from participating fully in the dominant social and economic order of Voyage in the Dark. Anna is textually constrained on three levels, which may be defined as economic, colonialist, and narrative. Imbricated within these is the question of gender, which functions to place Anna in a position of double-exclusion within the text. These forms of exclusion function at the levels of discourse and narrative; I would argue that Anna's position is not, therefore, a product of realist character 'flaws' but rather that her discursive placement within the novel offers insight into the ways in which colonialism and sexism function in terms of textuality.

Feminism and identity in the work of contemporary Iranian female artists

This practice-led project focuses on the Iranian context and the role of female Iranian artists using digital mediums to influence the social, political and environmental life of Iranian women. The exegetical component presents a discussion on the intersection between three theoretical areas of artistic practice in Iran; feminism, cross-cultural practice and digital image making. Particular concern to this study is the growing role of female Iranian artists in challenging the social status quo. This is conducted through an investigation of a number of Iranian female artists in the form of case studies and interviews and a discussion on the impacts of their work on the resulting creative practice portion of this study.

Emotional intelligence development in radiation therapy students: A longitudinal study

Purpose: Emotional intelligence (EI) is an increasingly important aspect of a health professional’s skill set. It is strongly associated with empathy, reflection and resilience; all key aspects of radiotherapy practice. Previous work in other disciplines has formed contradictory conclusions concerning development of EI over time. This study aimed to determine the extent to which EI can develop during a radiotherapy undergraduate course and identify factors affecting this. Methods and materials: This study used anonymous coded Likert-style surveys to gather longitudinal data from radiotherapy students relating to a range of self-perceived EI traits during their 3-year degree. Data were gathered at various points throughout the course from the whole cohort. Results: A total of 26 students provided data with 14 completing the full series of datasets. There was a 17·2% increase in self-reported EI score with a p-value<0·0001. Social awareness and relationship skills exhibited the greatest increase in scores compared with self-awareness. Variance of scores decreased over time; there was a reduced change in EI for mature students who tended to have higher initial scores. EI increase was most evident immediately after clinical placements. Conclusions: Radiotherapy students increase their EI scores during a 3-year course. Students reported higher levels of EI immediately after their clinical placement; radiotherapy curricula should seek to maximise on these learning opportunities.

The dynamics of individual teacher autonomy: A case study of teachers' work in a Queensland secondary school

The emphasis on collegiality and collaboration in the literature on teachers' work and school reform has tended to underplay the significance of teacher autonomy. This thesis explores the dynamics of teachers' understandings and experiences of individual teacher autonomy (as contrasted with collective autonomy) in an independent school in Queensland which promoted itself as a 'teachers' school' with a strong commitment to individual teacher autonomy. The research was a case study which drew on methodological signposts from critical, feminist and traditional ethnography. Intensive fieldwork in the school over five months incorporated the ethnographic techniques of observation, interviews and document analysis. Teachers at Thornton College understood their experience of individual autonomy at three interrelated levels--in terms of their work in the classroom, their working life in the school, and their voice in the decision-making processes of the school. They felt that they experienced a great deal of individual autonomy at each of these three levels. These understandings and experiences of autonomy were encumbered or enabled by a range of internal and external stakeholder groups. There were also a number of structural influences (community perceptions, market forces, school size, time and bureaucracy) emerging from the economic, social and political structures in Australian society which influenced the experience of autonomy by teachers. The experience of individual teacher autonomy was constantly shifting, but there were some emergent patterns. Consensus on educational goals and vision, and strong expressions of trust and respect between teachers and stakeholders in the school, characterised the contexts in which teachers felt they experienced high levels of autonomy in their work. The demand for accountability and desire for relatedness motivated stakeholders and structural forces to influence teacher autonomy. Some significant gaps emerged between the rhetoric of a commitment to individual teacher autonomy and decision-making practices in the school, that gave ultimate power to the co-principals. Despite the rhetoric and promotion of non-hierarchical structures and collaborative decision-making processes, many teachers perceived that their experience of individual autonomy remained subject to the exercise of 'partial democracy' by school leaders.

Forces shaping the future of work in a changing regional economy

This paper presents research which examined perceptions on the future of work in Queensland. It highlights the major drivers of change including: changing technology, demographics, increasing globalisation and economic shifts. Focus groups were conducted and findings show that Queensland businesses are acutely aware of the coming changes, but are less certain about how to respond. Current good practices plus recommendations for the future - particularly the lead role government and industry bodies need to play - are discussed. These recommendations will support Queensland businesses to thrive and adapt to the forces shaping work in this changing regional economy.