Emergency Health Services (EHS) : demand and service delivery models. monograph 3 : patients’ reasons and perceptions

Executive Summary Emergency health is a critical component of Australia’s health system and emergency departments (EDs) are increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the perspectives of users of both ambulance services and EDs. The research reported here aimed to identify the perspectives of users of emergency health services, both ambulance services and public hospital Emergency Departments and to identify the factors that they took into consideration when exercising their choice of location for acute health care. A cross-sectional survey design was used involving a survey of patients or their carers presenting to the EDs of a stratified sample of eight hospitals. A specific purpose questionnaire was developed based on a novel theoretical model which had been derived from analysis of the literature (Monograph 1). Two survey versions were developed: one for adult patients (self-complete); and one for children (to be completed by parents/guardians). The questionnaires measured perceptions of social support, health status, illness severity, self-efficacy; beliefs and attitudes towards ED and ambulance services; reasons for using these services, and actions taken prior to the service request. The survey was conducted at a stratified sample of eight hospitals representing major cities (four), inner regional (two) and outer regional and remote (two). Due to practical limitations, data were collected for ambulance and ED users within hospital EDs, while patients were waiting for or under treatment. A sample size quota was determined for each ED based on their 2009/10 presentation volumes. The data collection was conducted by four members of the research team and a group of eight interviewers between March and May 2011 (corresponding to autumn season). Of the total of 1608 patients in all eight emergency departments the interviewers were able to approach 1361 (85%) patients and seek their consent to participate in the study. In total, 911 valid surveys were available for analysis (response rate= 67%). These studies demonstrate that patients elected to attend hospital EDs in a considered fashion after weighing up alternatives and there is no evidence of deliberate or ill-informed misuse. • Patients attending ED have high levels of social support and self-efficacy that speak to the considered and purposeful nature of the exercise of choice. • About one third of patients have new conditions while two thirds have chronic illnesses • More than half the attendees (53.1%) had consulted a healthcare professional prior to making the decision. • The decision to seek urgent care at an ED was mostly constructed around the patient’s perception of the urgency and severity of their illness, reinforced by a strong perception that the hospital ED was the correct location for them (better specialised staff, better care for my condition, other options not as suitable). • 33% of the respondent held private hospital insurance but nevertheless attended a public hospital ED. Similarly patients exercised considered and rational judgements in their choice to seek help from the ambulance service. • The decision to call for ambulance assistance was based on a strong perception about the severity of the illness (too severe to use other means of transport) and that other options were not considered appropriate. • The decision also appeared influenced by a perception that the ambulance provided appropriate access to the ED which was considered most appropriate for their particular condition (too severe to go elsewhere, all facilities in one spot, better specialised and better care). • In 43.8% of cases a health care professional advised use of the ambulance. • Only a small number of people perceived that ambulance should be freely available regardless of severity or appropriateness. These findings confirm a growing understanding that the choice of professional emergency health care services is not made lightly but rather made by reasonable people exercising a judgement which is influenced by public awareness of the risks of acute health and which is most often informed by health professionals. It is also made on the basis of a rational weighing up of alternatives and a deliberate and considered choice to seek assistance from a service which the patient perceived was most appropriate to their needs at that time. These findings add weight to dispensing with public perceptions that ED and ambulance congestion is a result of inappropriate choice by patients. The challenge for health services is to better understand the patient’s needs and to design and validate services that meet those needs. The failure of our health system to do so should not be grounds for blaming the patient, claiming inappropriate patient choices.

Monitoring food and non-alcoholic beverage promotions to children

Food and non-alcoholic beverage marketing is recognized as an important factor influencing food choices related to non-communicable diseases. The monitoring of populations' exposure to food and non-alcoholic beverage promotions, and the content of these promotions, is necessary to generate evidence to understand the extent of the problem, and to determine appropriate and effective policy responses. A review of studies measuring the nature and extent of exposure to food promotions was conducted to identify approaches to monitoring food promotions via dominant media platforms. A step-wise approach, comprising ‘minimal’, ‘expanded’ and ‘optimal’ monitoring activities, was designed. This approach can be used to assess the frequency and level of exposure of population groups (especially children) to food promotions, the persuasive power of techniques used in promotional communications (power of promotions) and the nutritional composition of promoted food products. Detailed procedures for data sampling, data collection and data analysis for a range of media types are presented, as well as quantifiable measurement indicators for assessing exposure to and power of food and non-alcoholic beverage promotions. The proposed framework supports the development of a consistent system for monitoring food and non-alcoholic beverage promotions for comparison between countries and over time.

Elementary teachers’ knowledge of legislative and policy duties for reporting child sexual abuse

This study examined elementary school teachers’ knowledge of their legislative and policy-based reporting duties with respect to child sexual abuse. Data were collected from 470 elementary school teachers from urban and rural government and nongovernment schools in 3 Australian states, which at the time of the study had 3 different legislative reporting duties for teachers. Teachers completed the 8-part Teacher Reporting Questionnaire (TRQ). Multinomial logistic regression analysis was used to determine factors associated with (a) teachers’ legislation knowledge and (b) teachers’ policy knowledge. Teachers with higher levels of knowledge had a combination of pre- and in-service training about child sexual abuse and more positive attitudes toward reporting, held administration positions in their school, and had reported child sexual abuse at least once during their teaching career. They were also more likely to work in the state with the strongest legislative reporting duty, which had been in place the longest.

Recovering from the earthquake : early childhood teachers and children collaboratively telling stories about their experiences

Purpose – Traumatic events can cause post-traumatic stress disorder due to the severity of the often unexpected events. The purpose of this paper is to reveal how conversations around lived experiences of traumatic events, such as the Christchurch earthquake in February 2011, can work as a strategy for people to come to terms with their experiences collaboratively. By encouraging young children to recall and tell of their earthquake stories with their early childhood teachers they can begin to respond, renew, and recover (Brown, 2012), and prevent or minimise more stress being developed. Design/methodology/approach – The study involved collecting data of the participating children taking turns to wear a wireless microphone where their interactions with each other and with teachers were video recorded over one week in November 2011. A total of eight hours and 21 minutes of footage was collected; four minutes and 19 seconds of that footage are presented and analysed in this paper. The footage was watched repeatedly and transcribed using conversation analysis methods (Sacks, 1995). Findings – Through analysing the detailed turn-taking utterances between teachers and children, the orderliness of the co-production of remembering is revealed to demonstrate that each member orients to being in agreement about what actually happened. These episodes of story telling between the teachers and children demonstrate how the teachers encourage the children to tell about their experiences through actively engaging in conversations with them about the earthquake. Originality/value – The conversation analysis approach used in this research was found to be useful in investigating aspects of disasters that the participants themselves remember as important and real. This approach offers a unique insight into understanding how the earthquake event was experienced and reflected on by young children and their teachers, and so can inform future policy and provision in post-disaster situations.

Placement Trajectory : mapping the journeys of children and young people in out-of-home care

Significant problems confront our child protection out-of-home care system including: high costs; increasing numbers of children and young people entering and remaining in care longer; high frequency of placement movement; and, negative whole-of-life outcomes for children and young people who have exited care. National policy and research agendas recognise the importance of enhancing the evidence base in out-of-home care to inform the development of policy, programs and practice, and improve longitudinal outcomes of children and young people. The authors discuss the concept of placement trajectory as a framework for research and systems analysis in the out-of-home context. While not without limitations, the concept of placement trajectory is particularly useful in understanding the factors influencing placement movement and stability. Increasing the evidence base in this area can serve to enhance improved outcomes across the lifespan for children and young people in the out-of-home care system.

Comparison of three different dressings for partial thickness burns in children : study protocol for a randomised controlled trial

BACKGROUND: In the paediatric population, pain and distress associated with burn injuries during wound care procedures remain a constant challenge. Although silver dressings are the gold standard for burn care in Australasia, very few high-level trials have been conducted that compare silver dressings to determine which will provide the best level of care clinically. Therefore, for paediatric patients in particular, identifying silver dressings that are associated with lower levels of pain and rapid wound re-epithelialisation is imperative. This study will determine whether there is a difference in time to re-epithelialisation and pain and distress experienced during wound care procedures among Acticoat, Acticoat combined with Mepitel and Mepilex Ag dressings for acute, paediatric partial thickness burns. METHODS/DESIGN: Children aged 0 to 15 years with an acute partial thickness (superficial partial to deep partial thickness inclusive) burn injury and a burn total body surface area of perspectives of the dressings. DISCUSSION: The results of this study will determine the effects of three commonly used silver and silicone burn dressing combinations on the rate of wound re-epithelialisation and pain experienced during dressing procedures in acute, paediatric partial thickness burn injuries. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613000105741.

Early childhood education for sustainability : Queensland and Australian perspectives

Introduction Early childhood education for sustainability is an emerging field within education – a synthesis of early childhood education and education for sustainability. As a distinct field of educational inquiry and practice, it is less than 20 years old in Australia. My personal story is one that emerged from a background in primary school teaching where I worked in an Indigenous community teaching Aboriginal children. These experiences made me question the marginalization of Indigenous peoples in Australian society, the colonizing impacts of education, gave me deeper understandings of human-environment interactions, and the effects of poverty and powerlessness on options for Indigenous people both in Australia and elsewhere where peoples and their lands have been exploited. These teaching experiences took me back to university to undertake a degree in environmental studies to help me to better understand the nexus between society, environment and economy. Hence my background in education for sustainability comes as much from the social sciences as from the biological/ecological sciences...

"What's the problem?" One teacher's response to conflict in an early childhood classroom

Scholars in Context: Prospects and Transitions is an edited collection of papers from Face to Face, the 1996 University of Queensland Graduate School of Education Postgraduate Conference. It presents current research undertaken in one of Australia's largest and leading centres for postgraduate research in education. The book is divided into three sections: classrooms through different lenses, in which a variety of classroom related issues are addressed through a range of frameworks; the big picture: global issues, which provides national and international perspectives on policy and cultural issues in a range of education sectors; and framing the individual: perspectives and insights, which includes different strands of research into individuals' development in the context of families and schools. Scholars in Context: Prospects and Transitions demonstrates how current researchers maintain a commitment to innovation and rigour, despite the current uncertainties that bedevil higher education. The work presented here makes a significant contribution to many fields of education research. The range of issues this collection addresses, the variety of theoretical and analytical perspectives adopted, and the scholarship evidenced in each contribution, make this text a valuable compendium of very recent work in education research.

Media and information literacy : policy and strategy guidelines

In the evolving knowledge societies of today, some people are overloaded with information, others are starved for information. Everywhere, people are yearning to freely express themselves,to actively participate in governance processes and cultural exchanges. Universally, there is a deep thirst to understand the complex world around us. Media and Information Literacy (MIL) is a basis for enhancing access to information and knowledge, freedom of expression, and quality education. It describes skills, and attitudes that are needed to value the functions of media and other information providers, including those on the Internet, in societies and to find, evaluate and produce information and media content; in other words, it covers the competencies that are vital for people to be effectively engaged in all aspects of development.

Open access and scholarly books : Australian perspectives

This three-hour workshop tackles the crucial question of whether globally coordinated, market based approaches to funding open access monographs can support the unique needs of Australian research communities. The workshop takes place in the context of the release in August 2013 of the Book Industry Collaborative Council (BICC) report and especially the recommendations included in the chapter on scholarly book publishing in the humanities and social sciences. This workshop, with expert speakers from the BICC Committee and from across the scholarly publishing industry, will discuss the policy issues most likely to ensure that Australian scholarly communities and audiences are best served in an era of digital technology and globalisation. Australia must think globally and support developments that enhance the accessibility of publicly-funded research. Speakers will outline recent developments in scholarly monograph publishing including new Open Access initiatives and developments. Knowledge Unlatched, is one example of an attempt to create an internationally coordinated, market-based route to open access for Humanities, Arts and Social Sciences (HASS) monographs. Knowledge Unlatched, a not-for-profit London-based company is piloting a global library consortium approach to funding open access monographs and released its pilot program in early October with 28 titles from 13 publishers. The workshop invites discussion and debate from librarians, publishers, researchers and research funders on the role of international coordination and markets in securing a more open future for Australian HASS scholarship.

Teachers and academics researching together : children's views on play

An international early years project led by QUT and University of Iceland researchers has investigated children’s accounts of play and the teacher’s role in play in kindergarten settings. While most commonly associated with young children’s activities and the work of childhood, play is recognised also as an activity that extends over the life span, from early childhood to adulthood, and across cultures, worldwide. As shown in national and state policy and curriculum documents, play is being subjected increasingly to specific guidelines that address the physical environment and educator involvement in early years settings. Parents and educators have strong opinions regarding the value and place of play. Children also have strong views about play, although little is known about their views and what they think play encompasses, and the value of play in their everyday lives.

Pre-service teachers’ epistemic perspectives about philosophy in the classroom : it is not a bunch of ‘hippie stuff’

Using epistemic perspectives as a theoretical framework, this study investigated Australian pre-service teachers’ perspectives about knowing, knowledge and children’s learning, as they engaged in a semester-long unit on philosophy in the classroom. During the field experience component of the unit, pre-service teachers were required to teach at least one philosophy lesson. Pre-service teachers completed the Personal Epistemological Beliefs Survey at the beginning and end of the unit. They were also interviewed in focus groups at the end of the semester to investigate their views about children’s learning. Paired sample t-tests were used to explore changes in epistemic beliefs over time. Significant differences were found for only some individual items on the survey. However, when interviewed, pre-service teachers indicated that field experiences helped them consider children as competent ‘thinkers’ who were capable of engaging in philosophy in the classroom. They reported predominantly student-centred perspectives of children’s learning, although a process of adjudication (exploring disagreements and evidence for responses) was lacking in these responses.

Evolutionary Perspectives

The standard approach to industrial economics starts with the industry’s basic conditions, then runs through the structure–conduct–performance paradigm of industrial organization, and finally considers government regulation and policy. Most creative industries segments have been studied in this way, for example in Albarran (2002) and Caves (2000). These approaches use standard economic analysis to explain the particular properties and characteristics of a specific industrial sector. The overview presented here is different again. It focuses on the creative industries and examines their economic effect, specifically their contribution to economic evolu -tion. This is an evolutionary systems approach to industrial analysis, where we seek to understand how a sector fits into a broader system of production, consumption, technology, trade and institutions. The evolutionary approach focuses on innovation, economic growth and endogenous transformation. So, rather than using economics to explain static or industrial-organization features of the creative industries, we are using an open systems view of the creative industries to explain dynamic ‘Schumpeterian’ features of the broader economy. The creative industries are drivers of economic transformation through their role in the origination of new ideas, in consumer adoption, and in facilitating the institutional embedding of new ideas into the economic order. This is not a novel idea, as economists have long understood that particular activities are drivers of economic growth and development, for example research and development, and also that particular sectors are instrumental to this process, for example high-technology sectors. What is new is the argument that cultural and creative sectors are also a key part of this process of economic evolution. We will review the case for that claim, and outline purported mechanisms. We will also consider why policy settings in the creative industries should be more in line with innovation and growth policy than with industry policy.

How stable is the well-being of Australian mothers who care for young children with special health care needs?

Ninety-seven percent of children who have special health care needs are cared for by their mothers. These mothers cite that their informal care work can be intrinsically rewarding, however, the role is not without substantial difficulties and consequences. We investigated differences in the health and well-being of mothers whose young children do and do not have special health care needs. Quantitative data are drawn from Growing Up in Australia: The Longitudinal Study of Australian Children. This study employs a matched-case control methodology to compare the experiences of a group of 292 mothers whose children are identified as having long term special health care needs to those mothers whose children are typically developing at two time points; Wave 1 (2004) and Wave 3 (2008). The findings support previous research that mothers of children with special health care needs have poorer general health and mental health than mothers whose children do not have special needs. Mothers of children with special health care needs also perceived life as more difficult. Longitudinally, this study also shows that maternal well-being remains relatively stable during the years when children are transitioning to formal schooling. Implications for policy makers, practitioners and early childhood professionals are discussed.

Evidence of effectiveness : high level synthesis of research to prevent obesity and increase physical activity in children

Background Prevention of childhood obesity is a public health priority for Malaysia and many other countries. Physical activity for children is also decreasing at an alarming rate. Both conditions are associated with non-communicable diseases and with significant morbidity and mortality in later life. Systematic reviews of public health interventions provide a useful summary to inform public health practice by combining the results of a range of research studies on a specific intervention into a single report. Systematic reviews are deemed most valuable for health program development and evidence based practice. Unfortunately, many policy makers and practitioners are simply unaware of the evidence: which strategies which are most likely to provide benefit; and which strategies are known to be harmful or useless. This presentation provides a “birds eye” overview based upon recent (since 2007 to present) high quality systematic reviews of public health interventions. Method HealthEvidece.org and the Cochrane Library were searched for systematic reviews which evaluated interventions targeting obesity prevention and increasing physical activity for children. The findings of the included reviews were themed and summarized. Results Seven reviews were identified addressing obesity in the early years, and fifteen reviews addressing obesity more broadly in childhood. Additional reviews were identified aimed at increasing physical activity. The synthesis shows several strategies to be effective, however many popular strategies clearly are not. Several of the reviews were inconclusive due to an absence of robust primary studies. Amongst the findings, interventions undertaken in the school setting appear very promising. Conclusions There is significant evidence from systematic reviews to guide public health practice and policy, and to inform future research.