Emergency department nurses' understanding and experiences of implementing discharge planning

Aim: This paper is a report of a study conducted to describe emergency department nurses' understanding and experiences of implementing discharge planning. ---------- Background: Discharge planning in the emergency department is an important issue because of increased healthcare costs and greater emphasis on continuity of care. When executed as a collaborative process involving a multi-disciplinary team with the patient and family, discharge planning provides continuity of care for patients, less demand on hospitals, improvement in community services and in the services of other healthcare organizations. ---------- Method: The qualitative approach of phenomenography was used in this study. Thirty-two emergency department nurses were recruited between July and September 2005. Semi-structured interviews were conducted. ---------- Findings: From interviewees' descriptions of implementing discharge planning, six categories were established: implementing discharge planning as 'getting rid of my patients', completing routines, being involved in patient education, professionally accountable practice, autonomous practice and demonstrating professional emergency department nursing care. The referential meaning of implementing discharge planning 'in the outcome space' was the professional commitment to emergency department provision of effective discharge services. ---------- Conclusion: The results of this research contribute to knowledge of emergency department nurses' experience in the implementation of the discharge planning process. Key requirements for the provision of manageable discharge services both in Taiwan and worldwide highlighted by this study include adequate workloads, sufficient time, clear policies and standards of discharge planning and enhancement of professional commitment.

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.

How can entrepreneurial musicians use electronic social networks to diffuse their music

Principal Topic: ''In less than ten years music labels will not exist anymore.'' Michael Smelli, former Global COO Sony/BMG MCA/QUT IMP Business Lab Digital Music Think Thanks 9 May 2009, Brisbane Big music labels such as EMI, Sony BMG and UMG have been responsible for promoting and producing a myriad of stars in the music industry over the last decades. However, the industry structure is under enormous threat with the emergence of a new innovative era of digital music. Recent years have seen a dramatic shift in industry power with the emergence of Napster and other file sharing sites, iTunes and other online stores, iPod and the MP3 revolution. Myspace.com and other social networking sites are connecting entrepreneurial artists with fans and creating online music communities independent of music labels. In 2008 the digital music business internationally grew by around 25% to 3.7 Billion US-Dollar. Digital platforms now account for around 20% of recorded music sales, up from 15 % in 2007 (IFPI Digital music report 2009). CD sales have fallen by 40% since their peak levels. Global digital music sales totalled an estimated US$ 3 Billion in 2007, an increase of 40% on 2006 figures. Digital sales account for an estimated 15% of global market, up from 11% in 2006 and zero in 2003. The music industry is more advanced in terms of digital revenues than any other creative or entertainment industry (except games). Its digital share is more than twice that of newspapers (7%), films (35) or books (2%). All these shifts present new possibilities for music entrepreneurs to act entrepreneurially and promote their music independently of the major music labels. Diffusion of innovations has a long tradition in both sociology (e.g. Rogers 1962, 2003) and marketing (Bass 1969, Mahajan et al., 1990). The context of the current project is theoretically interesting in two respects. First, the role of online social networks replaces traditional face-to-face word of mouth communications. Second, as music is a hedonistic product, this strongly influences the nature of interpersonal communications and their diffusion patterns. Both of these have received very little attention in the diffusion literature to date, and no studies have investigated the influence of both simultaneously. This research project is concerned with the role of social networks in this new music industry landscape, and how this may be leveraged by musicians willing to act entrepreneurially. Our key research question we intend to address is: How do online social network communities impact the nature, pattern and speed that music diffuses? Methodology/Key Propositions : We expect the nature/ character of diffusion of popular, generic music genres to be different from specialized, niche music. To date, only Moe & Fader (2002) and Lee et al. (2003) investigated diffusion patterns of music and these focus on forecast weekly sales of music CDs based on the advance purchase orders before the launch, rather than taking a detailed look at diffusion patterns. Consequently, our first research questions are concerned with understanding the nature of online communications within the context of diffusion of music and artists. Hence, we have the following research questions: RQ1: What is the nature of fan-to-fan ''word of mouth'' online communications for music? Do these vary by type of artist and genre of music? RQ2: What is the nature of artist-to-fan online communications for music? Do these vary by type of artist and genre of music? What types of communication are effective? Two outcomes from research social network theory are particularly relevant to understanding how music might diffuse through social networks. Weak tie theory (Granovetter, 1973), argues that casual or infrequent contacts within a social network (or weak ties) act as a link to unique information which is not normally contained within an entrepreneurs inner circle (or strong tie) social network. A related argument, structural hole theory (Burt, 1992), posits that it is the absence of direct links (or structural holes) between members of a social network which offers similar informational benefits. Although these two theories argue for the information benefits of casual linkages, and diversity within a social network, others acknowledge that a balanced network which consists of a mix of strong ties, weak ties is perhaps more important overall (Uzzi, 1996). It is anticipated that the network structure of the fan base for different types of artists and genres of music will vary considerably. This leads to our third research question: RQ3: How does the network structure of online social network communities impact the pattern and speed that music diffuses? The current paper is best described as theory elaboration. It will report the first exploratory phase designed to develop and elaborate relevant theory (the second phase will be a quantitative study of network structure and diffusion). We intend to develop specific research propositions or hypotheses from the above research questions. To do so we will conduct three focus group discussions of independent musicians and three focus group discussions of fans active in online music communication on social network sites. We will also conduct five case studies of bands that have successfully built fan bases through social networking sites (e.g. myspace.com, facebook.com). The idea is to identify which communication channels they employ and the characteristics of the fan interactions for different genres of music. We intend to conduct interviews with each of the artists and analyse their online interaction with their fans. Results and Implications : At the current stage, we have just begun to conduct focus group discussions. An analysis of the themes from these focus groups will enable us to further refine our research questions into testable hypotheses. Ultimately, our research will provide a better understanding of how social networks promote the diffusion of music, and how this varies for different genres of music. Hence, some music entrepreneurs will be able to promote their music more effectively. The results may be further generalised to other industries where online peer-to-peer communication is common, such as other forms of entertainment and consumer technologies.

The ultra-low friction of the articular surface is pH-dependent and is built on a hydrophobic underlay including a hypothesis on joint lubrication mechanism

In this study, the influence of pH on interfacial energy distributed over the phospholipids-bilayer surface model and the effect of hydrophobicity on coefficient of friction (f) were investigated by using microelectrophoresis. An important clinical implication of deficiency in hydrophobicity is the loss of phospholipids that is readily observed in osteoarthritis joints. This paper establishes the influence of pH on interfacial energy upon an increase f, which might be associated with a decrease of hydrophobicity of the articular surface.

Modelling water droplet movement on a leaf surface

Modelling droplet movement on leaf surfaces is an important component in understanding how water, pesticide or nutrient is absorbed through the leaf surface. A simple mathematical model is proposed in this paper for generating a realistic, or natural looking trajectory of a water droplet traversing a virtual leaf surface. The virtual surface is comprised of a triangular mesh structure over which a hybrid Clough-Tocher seamed element interpolant is constructed from real-life scattered data captured by a laser scanner. The motion of the droplet is assumed to be affected by gravitational, frictional and surface resistance forces and the innovation of our approach is the use of thin-film theory to develop a stopping criterion for the droplet as it moves on the surface. The droplet model is verified and calibrated using experimental measurement; the results are promising and appear to capture reality quite well.

A New robot for environmental monitoring on the Great Barrier Reef

A vast amount of research into autonomous underwater navigation has, and is, being conducted around the world. However, typical research and commercial platforms have limited autonomy and are generally unable to navigate efficiently within coral reef environments without tethers and significant external infrastructure. This paper outlines the development and presents experimental results into the performance evaluation of a new robotic vehicle for underwater monitoring and surveying in highly unstructured environments. The hybrid AUV design developed by the CSIRO robotic reef monitoring team realises a compromise between endurance, manoeuvrability and functionality. The vehicle represents a new era in AUV design specifically focused at providing a truly lowcost research capability that will progress environmental monitoring through unaided navigation, cooperative robotics, sensor network distribution and data harvesting.