Tensions and constraints for nurses in hospital-in-home programmes

Economic necessity constrains health-care expenditure and waiting lists for hospital treatments remain high. As a result, more care is delivered via alternative means, such as same-day surgery initiatives and home-care programmes. Acute care delivered in the home to patients who would otherwise require hospitalization is becoming an increasingly acceptable means of treatment. These Hospital-in-the-Home programmes offer increased comfort while delivering comparable outcomes to many patient groups. The purpose of this paper is to generate discussion concerning the tensions that exist for nurses who practice in the home under the auspices of acute-care institutions. Data drawn from field work that formed part of a critical ethnography is used to generate the discussion. The larger research project explored the constructions of the role of the nurse in four Hospital-in-the-Home programmes in Victoria, Australia. It will be argued that there is significant pressure exerted upon nurses to support the imperative to reduce bed days in acute hospitals by transferring people to their home. At times, this agenda clashes with the nurses’ professional commitment to provide holistic patient care yet the dilemmas are largely unacknowledged and/or unrecognized by the nurses despite the tension they generate.

They went home: racialised spaces in contemporary picture books

This paper discusses Michel de Certeau’s theories of spatialised power and of resistance, especially his characterisation of what he describes as ‘tactics’ by which marginalised groups resist the strategies by which those in power gain and maintain control, in relation to a group of settler society picture books: Edna Tantjingu Williams, Eileen Wani Wingfield and Kunyi June-Anne McInerney’s Down the hole (2000); the Papunya School Book of Country and History (2001); Chiori Santiago and Judith Lowry’s Home to Medicine Mountain (1998); George Littlechild’s This Land Is My Land (1993); and Allen Say’s Home of the Brave (2002). These texts thematise colonial and assimilationist policies in Australia, Canada and the United States which required that racialised groups of children should be removed from their homes and families and placed in institutions. I argue that the first four of these texts position child readers both to understand the dislocation and pain caused by government policies such as those which enforced the removal of the Stolen Generation in Australia, and to appreciate the tactics of resistance by which children evaded or subverted institutional power. Home of the Brave deploys the symbolism of an adult’s journey into the past to show how strategies of repression serve to protect individuals and nations from shame and guilt, and demonstrates the transformative effects which result when the past is scrutinized.

Home range, habitat selection and diet of foxes (vulpes vulpes) in a semi-urban riparian environment

Between 2000 and 2002 the home range, habitat selection and diet of foxes were examined in the Dandenong Creek Valley, Melbourne, Australia. The mean home range was 44.6 ha (range 19.2–152.6 ha). A significant selection towards blackberry and gorse used as diurnal shelter was found during the day with an active avoidance of less structurally complex vegetation types. Although there was obvious selection of certain habitats, the diet of the foxes was highly general and opportunistic and thus offers little potential as a factor to manipulate in order to reduce fox abundance. Given the strong preference for blackberry and gorse as a shelter resource, a habitat-manipulation strategy is suggested whereby patches of blackberry and gorse are removed and replaced with less structurally complex vegetation. Such a strategy has the potential to influence the density of foxes in semi-urban riparian environments such as those discussed in this study.

Individual, social and home environment determinants of change in children's television viewing: the Switch-Play intervention

Understanding potential determinants of change in television (TV) viewing among children may enhance the effectiveness of programs targeting this behaviour. This study aimed to investigate the contribution of individual, social and home environment factors among 10-year-old Australian children to change in TV viewing over a 21-month period. A total of 164 children (49% boys) completed a 19-lesson (9-month) intervention program to reduce TV viewing time. Children completed self-administered surveys four times over 21 months (pre- and post-intervention, 6- and 12-month follow-up). Baseline factors associated with change in TV viewing during the intervention and follow-up periods were: ‘asking parents ≥once/week to switch off the TV and play with them’ (21.6 min/day more than those reporting <once/week, p = 0.007); being able to ‘watch just 1 h of TV per day’ (26.1 min/day less than those who could not, p = 0.010); ‘watching TV no matter what was on’ (36.6 min/day more than those who did not, p < 0.001); and ‘continuing to watch TV after their program was over’ (33.0 min/day more than those who did not, p = 0.006). With every unit increase in baseline frequency of TV viewing with family and friends, children spent on average 4.0 min/day more watching TV over the 21-month period (p = 0.047). Baseline number and placement of TVs at home did not predict change in children's TV viewing over the 21 months. Greater understanding of the family dynamics and circumstances, as well as the individual and social determinants of TV viewing, will be required if we are to develop effective strategies for reducing TV viewing in children.

Development and reliability of a self-report questionnaire to examine children's perceptions of the physical activity environment at home and in the neighbourhood

Background: Environmental factors are increasingly being implicated as key influences on children's physical activity. Few studies have comprehensively examined children's perceptions of their environment, and there is a paucity of literature on acceptable and reliable scales for measuring these. This study aimed to develop and test the acceptability and reliability of a scale which examined a broad range of environmental perceptions among children.
Methods: Based on constructs from ecological models, a survey incorporating items on children's perceptions of the physical and social environment at home and in the neighbourhood was developed. This was administered on two occasions, nine days apart, to a sample of 39 children aged 11 years (54% boys), attending a metropolitan Australian elementary school. The acceptability of the survey was determined by the proportion of missing responses to each item. The test-retest reliability of individual items, scores and scales were determined using Kappa statistics and percent agreement for categorical variables, and intraclass correlation coefficients (ICC) for continuous variables.
Results: There were few missing responses to each question, with only 4% of all responses missing. Although some Kappa values were low, all categorical variables showed acceptable reliability when examined for percent agreement between test and retest (range 68%–100% agreement). Continuous variables all showed moderate to good ICC values (range 0.72–0.92).
Conclusion: Findings suggest this questionnaire is reliable and acceptable to children for assessing environmental perceptions relevant to physical activity among 11-year-old children.

How ophthlamic day surgery patients convalesce at home : an exploration of the salient issues

Cataract surgery is the most commonly performed surgical procedure in Australia. In the next 10-15 years, the number of people needing this surgery is expected to double, This article is based on a study, which explored the types and levels of symptoms experienced by patients post-ophthalmic surgery. Patients were asked to complete two instruments: a 'Postoperative Symptoms Diary' and a follow up 'Telephone Survey Questionnaire'. Eight males and 15 females (n = 23) with a mean age of 80.5 years were recruited. The findings revealed that patients' symptom levels decreased over time, except for tiredness and moving around which increased slightly on Day 4 post-operatively. A carer was required for an average of 2.3 days. This study highlighted the discrepancies in current day surgery literature, which recommend that a carer is needed during only the first 24 hours post-operatively.

Tongan and European children`s interactions at home in urban New Zealand

Three- and four-year-old children have a range of culturally specific opportunities to develop social skills at home. In culturally diverse environments such as New Zealand, interplay between ethnic group, caregivers' expectations, and children's home interactions is important because different cultural groups share common educational and health systems. In this exploratory study, we compared three and four-year-old children's interactions with adults and older siblings in Tongan (N = 5) and European (N = 5) families who had lived in urban New Zealand for one to five generations. Adults' ideas of appropriate behaviors for their young children provided the basis for interpreting quantitative data obtained from counts of selected verbal and nonverbal behaviors, and measures of children's active involvement in their interactions. Tongan children had similar patterns of interaction with adults and older siblings. European children were more verbal and tended to elicit more ongoing interactions with adults versus siblings. We also compared the interactions of Tongan and European children directly. European children's interactions with adults were more verbal than those of Tongan children. European children were more successful at achieving ongoing interactions with adults. These cultural differences reflected caregivers' ideas of child-appropriate behavior. While all children demonstrated social skills that were important in their respective homes and communities, European children had more opportunities to develop patterns of child–adult interaction that are rewarded in New Zealand schools.

There's no place like home : unhomely moments in three postcolonial picture books

One of the principal strands of postcolonial theory and critical practice is the interrogation of received versions of colonial history. This paper investigates the extent to which three contemporary picture books, Gavin Bishop's The House that Jack Built, John Marsden and Shaun Tan's The Rabbits, and Thomas King and William Kent Monkman's A Coyote Columbus Story, mobilise postcolonial strategies in their representations of place. In particular, it focuses on how postcolonial textuality unsettles and transgresses notions of "homeliness" in narratives involving the displacement of colonised and colonising peoples. As the shifting power relations of colonialism render unhomely what has previously been homely (especially for colonised peoples), so they involve a contrary move in which unhomely spaces are changed into simulacra of lost or abandoned homes. Drawing upon Walter Benjamin's formulation of materialist historiography, Homi Bhabha describes what he terms 'the unhomely moment' as that in which personal and psychic histories intersect with the violent dislocations of colonialism. This paper will argue that such unhomely moments shape the visual and verbal narratives of The House that Jack Built, The Rabbits and A Coyote Columbus Story, all of which deal with the trauma which occurs when cultures previously geographically and psychically distant are brought into close contact with each other. Written to and for children who are citizens of postcolonial cultures, these texts disclose the unease which persists in contemporary societies where colonial histories are rehearsed and revisioned. However, the paper will argue that the three texts position readers in quite different ways; for instance, while the verbal text of The Rabbits constructs an implied author capable of speaking for the colonised and offering readers a very circumscribed subject position, Thomas King's narrative in A Coyote Columbus Story engages in a dialogic playfulness which allows readers to adopt a variety of reading positions. For each text, some key representations of unhomely moments will be considered, and the paper will explore the extent to which they construct forms of temporality which negotiate the space between history and its significances within crosscultural and intercultural formations.

The use of home experimentation kits for distance students in first-year undergraduate electronics

Laboratory and practical classes are an important part of the education of students in electronics and electrical engineering. "Hands-on" experience is critical for any engineer working in these fields in particular. For many years, delivering engineering practicals to distance-education students has been a tremendous challenge for universities. For a number of years now, students enrolled in the common first-year electronics course by distance mode at Deakin University have received a home experimentation kit. Using the kit and a laboratory manual, students are required to complete a number of experiments based on components included in the kit. The kit supports a full range of practical activities for digital electronics, and a more limited range of activities for analog electronics. With the kit, off campus students are supplied software for simulating AC electronic circuits, such as amplifiers and rectifiers. In this report we examine the past use of this kit and software,
review anecdotal student experiences with the package, and propose changes to it and to other curriculum resources, aiming to enhance the use of the kit by distance students. Key curriculum resources planned are a web-based 'companion' for the components in and the use of the kit, and two additions to the kit itself: a battery powered function generator, and a PC-based oscilloscope.

Home, school, community and their role in the provision of music education

The Department of Education, Science and Training (DEST), is supporting under the Australian Government Quality Outcomes Programme, a National Review of School Music Education. The review, which is intended to submit its report in mid 2005, is interested in investigating the current quality of teaching and learning of music in both primary and secondary schools. It aims to provide examples of best practice of teaching and learning of music, along with a set of recommendations for the development of future approaches and directions to improve the quality of music education offerings in Australian schools. This paper puts forward some proposals for consideration that will be forwarded to the Review and aims to generate debate about future approaches to the delivery of music education in Australian primary schools.
It argues that the home, school and community all have an important part to play in the music education of children, but that at present these three entities are insufficiently connected on a number of fronts, not least being an understanding about the purpose of young people’s engagement with music. There is no doubt that interest in the arts amongst Australians generally is high. A recent Australia Council report revealed that 85 per cent of its respondents agreed the arts are and should be an important part of the education of every young Australian and that what was needed was better arts education and opportunities for all young people. However, the opportunities need not be confined to those offered by the school sector. Engagement with out-of-school music includes both music encountered in the home, which may be affected by family influence, and music provided by the diversity of community organizations, which serve a real and complimentary role to classroom learning and achieve learning outcomes that schools often do not have the resources to foster. A number of proposals for action are suggested for consideration by those involved in education as a means of progressing the discussion. It asserts that there is much valuable activity occurring within the three locales of school, home and community, but a firmer relationship could be forged across all three to ensure young people’s on-going, life-long enjoyable engagement with music.

A longitudinal evaluation of nursing home care quality in Taiwan

Aging populations worldwide have important implications for elderly care composition and quality, particularly with regard to care provided by nursing homes. Our study investigated quality of nursing home care in Taiwan using resident satisfaction and clinical outcomes as indicators.
We randomly recruited 306 residents in 13 nursing homes and assessed them at initial, 3, 6, and 12-months follow-up. The outcomes of the nursing home care in the 12-month follow-up period showed significant decreases in pressure sores and moderate satisfaction of nursing home care, but increases in physical restraints and psychological loneliness. Study results suggest that longterm nursing home care may improve residents' quality of life. However, to achieve this, nursing homes must provide improved psychological support for residents and decrease the use ofphysical
restraints.

Is rehabilitation associated with change in functional status among nursing home residents?

Assessing functional status of residents in nursing homes is one way to evaluate the quality of care provided. The purpose of this study was to investigate whether rehabilitation interventions could lead to improved functional independence. A prospective study was carried out to examine the change in activities of daily living (ADL) of 310 residents aged 65 or above over a period of 6 months. About 41.3% (n = 128) received rehabilitation therapy. Functional improvement was observed in 30.6% of the participants. The corresponding figures for stabilization and functional decline were 45.2% and 24.2%, respectively. Using a multinomial logistic regression, we found that factors significantly associated with change in functional status included baseline ADL score, family visit, number of beds in the institution, and transfer to acute hospitals. After adjusting for these confounding variables, change in functional status of those who received rehabilitation and those who did not was not significantly different.

At home on the road? Can drivers' relationships with their cars be associated with territoriality?

The current research explores the relationship between people and their cars within the framework of Altman's theory of human territoriality. It further develops the research of Sandqvist by examining the descriptions given by people with differing ownership and uses of their cars and exploring the congruence between these and the characteristics used to describe human territories. Thirteen focus groups were held with young drivers between the ages of 18 and 25 years, drivers over the age of 25 who are parents of pre-license age children, drivers over the age of 25 who do not regularly transport children, and drivers of work vehicles. Analyses of discussions revealed that drivers’ descriptions of the relationship with their car could be matched with Brown and Altman's descriptions of territory types. However, variations existed both between and within individuals as to the application of the labels ‘primary’, ‘secondary’ and ‘public’ territory to the car. Implications for the understanding of road user behaviour and the further development of theory on the car as a place or an object in terms of territoriality are discussed.