Discharge planning in the emergency department : a comprehensive approach

Discharge planning has become increasingly important, with current trends toward shorter hospital stays, increased health care costs, and more community-based health services. Effective discharge planning ensures the safety and ongoing care for patients,1 and it also benefits health care providers and organizations. It results in shorter hospital stays, fewer readmissions, higher access rates to post-hospitalization services, greater patient satisfaction with the discharge, and improved quality of life and continuity of care.[2] and [3] All acute care patients and their caregivers require some degree of preparation for discharge home—education about their health status, risks, and treatment; help setting health goals and maintaining a good level of self-care; information about community resources; and follow-up appointments and referrals to appropriate community health providers. Inadequate preparation exposes the patient to unnecessary risks of recurrence or complications of the acute complaint, neglect of nonacute comorbidities, mismanagement and side effects of medication, disruption of family and social life, emotional distress, and financial loss.[2], [3] and [4] The result may be re-presentation to the emergency department. It is noteworthy that up to 18% of ED presentations are revisits within 72 hours of the original visit5; many of these are considered preventable.6 It is a primary responsibility of nurses to ensure that patients return to the community adequately prepared and with appropriate support in place. Up to 65% of ED patients are discharged home from the emergency department,7 and the characteristics of the emergency department and its patient population make the provision of a high standard of discharge planning uniquely difficult. In addition, discharge planning is neglected in contemporary emergency nursing—there are no monographs devoted to the subject, and there is little published research. In this article 3 issues are explored: the importance of emergency nurses’ participation in the discharge-planning process, impediments to their participation; and strategies to improve discharge planning in the emergency department.

Community engagement : exploring a relational approach to consultation and collaborative practice in Australia

Community engagement is increasingly being employed by Australian organizations as a key strategy to incorporate representative community opinions into decision-making. This trend is reflected by Australian local and state governments legislating for community consultation in major infrastructure projects and the increasing role of public relations practitioners to manage these programs. This study explores community engagement founded on relational theory and proposed a typology of engagement employing a relational framework. An exploratory study of 20 Australian infrastructure projects with a mandatory consultation component is analyzed applying this framework. Results indicate little discrimination between the terms engagement, consultation, and participation; however, a range of tactics supported both collaborative and advocacy approaches. The implications for adopting a relational framework for community engagement programs are discussed.

Community engagement for sustainable urban futures : editorial preface

This special issue of Futures is concerned with community engagement strategies that help to inform medium and long-term futures studies in order to foster sustainable urban environments. Recent special issues of Futures, such as Human Extinction (41:10) and Utopian Thought (41:4), reflect the increasing significance of sustainability issues, which is why we present another crucial component of sustainability, community engagement. Responding to futurists’ long term concerns about climate change outlined in Futures 41(9) [1], Stevenson concluded that we can no longer support infinite growth, and that our goal should be to reshape the economy to let us live within our means. In the face of the continued and accelerated crisis in environmental, economic and social sustainability, a number of trends informed our call for papers on the possible role of community engagement in contributing to enhanced urban sustainability: • Changes in the public sphere in terms of participation, online deliberation systems, polity of urban futures; • The possible use of user-generated content for urban planning (paralleling the rise of user generated content elsewhere); • The related role of social networking, collective and civic intelligence, and crowd- sourcing in urban futures; • The rise of technologies such as wireless Internet and mobile applications, and the impact of neogeography, simulations and 3D virtual environments that reproduce and analyse complex social phenomena and city systems in urban futures, design and planning.

Does research into sensitive areas do harm? Experiences of research participation after a child’s diagnosis with Ewing’s Sarcoma

Objective: To investigate family members’ experiences of involvement in a previous study (conducted August 1995 to June 1997) following their child’s diagnosis with Ewing’s sarcoma. Design: Retrospective survey, conducted between 1 November and 30 November 1997, using a postal questionnaire. Participants: Eighty-one of 97 families who had previously completed an in-depth interview as part of a national case–control study of Ewing’s sarcoma. Main outcome measures: Participants’ views on how participation in the previous study had affected them and what motivated them to participate. Results: Most study participants indicated that taking part in the previous study had been a positive experience. Most (n = 79 [97.5%]) believed their involvement would benefit others and were glad to have participated, despite expecting and finding some parts of the interview to be painful. Parents whose child was still alive at the time of the interview recalled participation as more painful than those whose child had died before the interview. Parents who had completed the interview less than a year before our study recalled it as being more painful than those who had completed it more than a year before. Conclusions: That people suffering bereavement are generally eager to participate in research and may indeed find it a positive experience is useful information for members of ethics review boards and other “gatekeepers”, who frequently need to determine whether studies into sensitive areas should be approved. Such information may also help members of the community to make an informed decision regarding participation in such research.

Web-based and traditional public participation in comprehensive planning : a comparative study

The present paper examines whether the potential advantages of the expanding practice of web-based public participation only complement the benefits of the traditional techniques, or are empowering enough to replace them. The question is examined in a real-world case of neighbourhood revitalization, in which both techniques were practiced simultaneously. Comparisons are made at four major planning junctions, in order to study the contributions of each technique to the qualities of involvement, trust, and empowerment. The results show that web-based participants not only differ from the participants of traditional practices, but they also differ from each other on the basis of their type of web participation. The results indicate that web-based participation is an effective and affective complementary means of public participation, but it cannot replace the traditional unmediated techniques.

Community voices, votes and action

The diversity of community voices in the SEQ ‘bellwether region’ has grown from a muted murmur in the mid twentieth century supporting provision of urban services, rural conservation and green belts, to the current clamour against over-development, and in favour of protecting local and regional open space, wetlands and natural habitats. This in turn has often resulted in vigorous campaigns against unpopular roads, dams, dumps and tall buildings. In the last twenty years community issues have played a major part in local government elections throughout the region and have even helped unseat (in 1995-1996) a state government which discounted their authenticity and community resolve.

Productions of space : civic participation of young people at university

Civic participation of young people around the world is routinely described in deficit terms, as they are labelled apathetic, devoid of political knowledge, disengaged from the community and self-absorbed (Andolina, 2002; Weller, 2006). This paper argues that the connectivity of time, space and social values (Lefebvre, 1991; Soja, 1996) are integral to understanding the performances of young people as civic subjects. Today’s youth negotiate unstable social, economic and environmental conditions, new technologies and new forms of community. Loyalty, citizenship and notions of belonging take on new meanings in these changing global conditions. Using the socio-spatial theories of Lefebvre and Foucault, and the tools of critical discourse analysis, this paper argues that the chronotope, or time/space relationship of universities, produces student citizens who, in resistance to a complex global society, create a cocooned space which focuses on moral and spiritual values that can be enacted on a personal level.

Social inclusion through community enterprise? Examining the available evidence

In recent years the concepts of social inclusion and exclusion have become part of the repertoire of third-way policy discourses that seek to respond to complex socioeconomic problems through processes of 'joined-up' and 'integrated' governance. As part of this approach, we are witnessing an increased focus on the role of the third sector in facilitating social inclusion. While the push towards governing through networks has gained moral legitimacy in some areas of social policy, the practical legitimacy - that is, whether these new approaches actually produce demonstrably better outcomes than more traditional policy approaches - remains largely unsubstantiated. This article contributes to the evidence base, by examining the social-inclusion impacts of eleven community enterprises operating in Victoria, and to the wider available evidence on the social, economic and civic effects of social enterprise.

The old face of 'new' social networks : the republic of letters as a virtual community

This paper explores the idea of virtual participation through the historical example of the republic of letters in early modern Europe (circa 1500-1800). By reflecting on the construction of virtuality in a historical context, and more specifically in a pre-digital environment, this paper calls attention to accusations of technological determinism in ongoing research concerning the affordances of the Internet and related media of communication. It argues that ‘the virtual’ is not synonymous with ‘the digital’ and suggests that, in order to articulate what is novel about modern technologies, we must first understand the social interactions underpinning the relationships which are facilitated through those technologies. By analysing the construction of virtuality in a pre-digital environment, this paper thus offers a baseline from which scholars might consider what is different about the modes of interaction and communication being engaged in via modern media.

Aboriginal community control and decolonizing health policy : a yarn from Australia

This chapter outlines: a brief history of Australian Aboriginal health and health policy and then moves on to demonstrate how the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) undertakes its work and is an example of 'decolonizing policy in action'. Moreover, it highlights how Aboriginal participation in the development of policy and in the planning, delivery, management and evaluation of health programs enables policies and programs to respond effectively to the needs of Aboriginal people and to change future health outcomes for them. It showcases how Aboriginal decision-making has gone some way to decolonizing policymaking and has addressed the power imbalance - both of which have been critical in the improvement in Aboriginal health outcomes.

Community engagement and groundwater investigation in a rural/peri urban basaltic aquifier system, Tamborine Mountain, South East Queensland

The Tamborine Mt area is a popular residential and tourist area in the Gold Coast hinterland, SE Qld. The 15km2 area occurs on elevated remnant Tertiary Basalts of the Beechmont Group, which comprise a number of mappable flow units originally derived from the Tweed volcanic centre to the south. The older Albert Basalt (Tertiary), which underlies the Beechmont Basalt at the southern end of the investigation area, is thought to be derived from the Focal Peak volcanic centre to the south west. The Basalts contain a locally significant ‘un-declared’ groundwater resource, which is utilised by the Tamborine Mt community for: • domestic purposes to supplement rainwater tank supplies, • commercial scale horticulture and • commercial export off-Mountain for bottled water. There is no reticulated water supply, and all waste water is treated on-site through domestic scale WTPs. Rainforest and other riparian ecosystems that attract residents and tourist dollars to the area, are also reliant on the groundwater that discharges to springs and surface streams on and around the plateau. Issues regarding a lack of compiled groundwater information, groundwater contamination, and groundwater sustainability are being investigated by QUT, utilising funding provided by the Federal Government’s ‘Caring for our Country’ programme through SEQ Catchments Ltd. The objectives of the two year project, which started in April 2009, are to: • Characterise the nature and condition of groundwater / surface water systems in the Tamborine Mountain area in terms of the issues being raised; • Engage and build capacity within the community to source local knowledge, encourage participation, raise awareness and improve understanding of the impacts of land and water use; • Develop a stand-alone 3D Visualisation model for dissemination into the community and use as a communication tool.

Social clubs and social capital : the effect of electronic gaming machines in disadvantaged regions on the creation or destruction of community resilience

The role of particular third sector organisations, Social Clubs, in supporting gambling through the use of EGMs in venues presents as a difficult social issue. Social Clubs gain revenue from gambling activities; but also contribute to social well-being through the provision of services to communities. The revenues derived from gambling in specific geographic locales has been seen by government as a way to increase economic development particularly in deprived areas. However there are also concerns about accessibility of low-income citizens to Electronic Gaming Machines (EGMS) and the high level of gambling overall in these deprived areas. We argue that social capital can be viewed as a guard against deleterious effects of unconstrained use of EGM gambling in communities. However, it is contended that social capital may also be destroyed by gambling activity if commercial business actors are able to use EGMs without community obligations to service provision. This paper examines access to gambling through EGMs and its relationship to social capital and the consequent effect on community resilience, via an Australian case study. The results highlight the potential two-way relationship between gambling and volunteering, such that volunteering (and social capital more generally) may help protect against problems of gambling, but also that volunteering as an activity may be damaged by increased gambling activity. This suggests that, regardless of the direction of causation, it is necessary to build up social capital via volunteering and other social capital activities in areas where EGMS are concentrated. The study concludes that Social Clubs using EGMs to derive funds are uniquely positioned within the community to develop programs that foster social capital creation and build community resilience in deprived areas.

Designing for participation in local social ridesharing networks : grass roots prototyping of IT systems

This abstract explores the possibility of a grass roots approach to engaging people in community change initiatives by designing simple interactive exploratory prototypes for use by communities over time that support shared action. The prototype is gradually evolved in response to community use, fragments of data gathered through the prototype, and participant feedback with the goal of building participation in community change initiatives. A case study of a system to support ridesharing is discussed. The approach is compared and contrasted to a traditional IT systems procurement approach.

Iterative design within a local community communication fabric

Our research considers the problem designing support for local community communications. We present a description of a suburban community communication fabric as revealed through observations of long-term use of a networked community noticeboard and the introduction of tailored email digest to registered noticeboard users. The paper contributes an understanding of how iterative situated design in a user community can help us to design for participation in the use of technologies that can support growth of a community communication fabric. The different roles of the situated display and email digest are discussed.