Scope of practice of occupational therapists working in Victorian community health settings

Background/aim: Current health policy places emphasis on community-based health care and it is expected that there will be an increase in the number of people receiving care in community settings. This study aimed to examine the profile and scope of practice of occupational therapists working in Victorian community health settings and the amount and type of health promotion activity incorporated into their role.
Method:  An anonymous postal questionnaire was sent to 205 community-based Victorian occupational therapists. One hundred and one (49.3% response rate) questionnaires were returned, with 72 respondents (35.1%) meeting study inclusion criteria. A descriptive research design was used to address study aims.
Results:  Results indicate that the majority of community health occupational therapists are experienced practitioners, have a varied scope of practice and report a high level of job satisfaction. Compared with previous studies, there is an increase in new graduate occupational therapists starting their career in community health settings, a greater number of part-time workers and a diversification of clinical and non-clinical roles. Barriers to practice that exist include high demand for service, limited funding and time spent on administrative tasks. Although health promotion was regarded as an important role of community health workers, a large number of therapists were not involved in this activity because of limited knowledge and clinical work taking priority.
Conclusion: Study findings have implications for occupational therapy training, and there is a clear need for input at policy level to address the significant resource allocation issues raised.

Nutrition screening of older people in a community general practice, using the MNA-SF

Background: Objective The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition.

Design Cross-sectional study of nutritional risk screen conducted over a six month period.

Participants and setting Patients attending a general practice clinic in Victoria, Australia, who attended for the “75 plus” health assessment check.

Measurements The Mini Nutritional Assessment Short Form (MNA®-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA®-SF score recorded.

Results Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA®-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 ± 0.8 (SEM) vs 27.4 ± 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category.

Conclusion In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese.

Scope of practice in forensic nursing

1. There is significant role variation, across the Western world, in relation to how forensic nurses practice. 2. The authors conducted a pilot survey of forensic nurses in Australia, New Zealand, the United States, and the United Kingdom to examine forensic nursing practice, role definition, and role boundaries. 3. Issues arising from the data include the visibility of forensic nurses, the client group, forensic-specific education, and role development.

The evolution of an online community - a case study

This article reflects findings from a long term case study of an online community of practice established through a network for the professional education of teachers in Ontario, Canada. The Education Network of Ontario/Réseau éducatif de l'Ontario (ENO/REO) was created in 1992–1993 to support and connect teachers from kindergarten to grade 12 in the province of Ontario. Its mandate was to ensure that all teachers had free access to the Internet and to each other and to encourage the development of skills in the area of information and communication technology with the ultimate goal of using those skills to improve classroom practice. The study investigated whether information technology had the potential to connect teachers to each other in order to build the capacity to create networks where professional learning could take place in a cost-efficient and flexible time and/or place. It was found that participants were early adopters who enjoyed innovation, that online networkswere supportive for learning but hard to maintain over time, and though they supported the integration of technology in the classroom, other barriers within schools could challenge this effect.

Engaging rural communities in health care through a paramedic expanded scope of practice

Introduction: This article explores how community engagement by paramedics in an expanded scope role contributes to both primary health care and to an overall improved emergency response capacity in rural communities. Understanding how expanded scope paramedics (ESP) can strengthen community healthcare collaborations is an important need in rural areas where low workforce numbers necessitate innovation.

Methods: Four examples of Australian rural ESP roles were studied in Tasmania, New South Wales, South Australia and Victoria to gather information on consistent elements that could inform a paramedic expanded scope model. Qualitative data were collected from semi-structured interviews with key stakeholders and organisational documents. Thematic analysis within and across cases found community engagement was a key element in the varied roles. This article relies heavily on data from the Victorian and Tasmanian case studies because community engagement was a particularly strong aspect of these cases.

Results: The ESP in the case studies increased interactions between ambulance services and rural communities with an overall benefit to health care through: increasing community response capacity; linking communities more closely to ambulance services; and increasing health promotion and illness prevention work at the community level. Leadership, management and communication skills are important for paramedics to successfully undertake expanded scope roles.

Conclusion: ESP in rural locations can improve health care beyond direct clinical skill by active community engagement that expands the capacity of other community members and strengthens links between services and communities. As health services look to gain maximum efficiency from the health workforce, understanding the intensification of effort that can be gained from practitioner and community coalitions provides important future directions.

Zones of practice : embodiment and creative arts research

This article presents the trans-disciplinary encounters with and perspectives on embodiment of three creative-arts practitioners within the Deakin University research project Flows & Catchments. The project explores how creative arts participate in community and the possibility of well-being. We discuss our preparations for creative work exhibited at the 2012 Lake Bolac Festival un regional Western Victoria, Australia

Advancing community engagement practice for strategic urban planning : learning from allied and remote disciplines

Urban planning has the potential to draw on allied and remote disciplines to improve community consultation processes for strategic planning projects. Urban design and landscape architecture have quantitative and qualitative methods which can be utilised to visualise different options of urban intensification which may fit within communities’ expectations of change. Furthermore political science has long used scientifically established psychometric techniques to collect data from broad sections of the population, analysing demographic profiles of communities and understanding their perceptions and attitudes. By appropriating quantitative and qualitative methods from other disciplines, urban planning policies can be developed which may reflect communities’ aspirations of amenity and neighbourhood character. The aim of this paper is to assist local government urban planners with their community engagement practice in order to form policies which are acceptable to the affected communities. The paper draws on Victoria as a case study of community engagement practice, examines research methods from allied and remote disciplines and proposes a community engagement framework which introduces rigour within the community engagement process.

Leaning towards collegiality: narratives of university communities of practice

This study explored the relationship between professional learning, community, narrative and identity in strategic communities established to enhance teaching and learning at three Australian universities. It adds to the field by proposing an adaptive model for understanding and fostering future communities of practice in higher education.

A trial of nurse practitioner scope of practice

Aims. The aim of this paper is to report a trial to investigate the feasibility of the nurse practitioner role in local health service delivery and to provide information about the educational and legislative requirements for nurse practitioner practice.

Background. Nurse practitioners have been shown to offer a beneficial service and fill a gap in health care provision. However, the lack of publications describing, critiquing, or defending the way that existing nurse practitioner roles have been developed may lead to a lack of clarity in comparing the nurse practitioner scope of practice internationally. In Australia, credible exploratory research is needed to realize the potential of nurse practitioners to bridge the divide of inequitable distribution of health services. A trial of nurse practitioner services in the Australian Capital Territory provided an excellent opportunity to investigate these scope and continuity issues.

Methods. This was an observational analytic study using multiple data sources. Four models of nurse practitioner service were chosen from a competitive field of applications that were evaluated according to efficacy, feasibility, and sustainability across specified selection criteria. Each model in the trial included a clinical support team, with the nurse practitioner candidate 'working-into-the-role' and collecting demographic, clinical practice, patient outcome, and health service and consumer survey data over a 10 month period.

Findings. The trial identified the broad potential of the nurse practitioner role, its breadth and limitations, and its impact on selected health services in the Australian Capital Territory. Data from individual models were compared highlighting generic elements, and formed the basis for the development of the scope of practice for the Australian Capital Territory nurse practitioner models.

Conclusions. This study has validated a research-based, iterative process for initial development of nurse practitioner scope of practice for any Australian specialization. Importantly, the study concluded with the scope of practice as a finding, rather than commencing with it a priori. Although general areas of health care need and under-servicing were identified at the outset, the process tested both the expansion and parameters of the roles.

Foucault's 'What is an author' : towards a critical discourse of practice as research

A vexed issue for many artistic researchers is related to the need for the artist/researcher to write about his or her own work in the research report or exegesis. In the creative arts, the outcomes that emerge from an alternative logic of practice are not easily quantifiable and it can be difficult to articulate conclusions objectively given the emotional and ideological investments and the intrinsically subjective dimension of the artistic process. How then, might the artist as researcher avoid on the one hand, what has been referred to as 'auto-connoisseurship', the undertaking of a thinly veiled labour of valorising what has been achieved in the creative work, or alternatively producing a research report that is mere description or history?

In this paper I suggest that a way of overcoming such a dilemma is for creative arts researchers to shift the critical focus away from the notion of the work as product, to an understanding of both studio enquiry and its outcomes as process. I’d like to draw on Michel Foucault’s essay ‘What is An Author ‘ to explore how we might move away from art criticism to the notion of a critical discourse of practice-led enquiry that involves viewing the artist as a researcher, and the artist/critic as a scholar who comments on the value of the artistic process as the production of knowledge.

Foucault’s essay provides artistic researchers with a template for more objective and distanced discourse on the practice-led research process and its writing. It allows researchers to locate themselves within contexts of theory and practice and provides an analytical framework though which researchers might locate themselves and their work within the broader social arena and field of research, As I will show with reference to the work of Donna Haraway and a number of commentaries on Pablo Picasso’s Demioselles d’Avignon, an application of Foucault’s ideas need not negate those subjective and situated aspects of practice as research.

Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department

This study examined the emergency nurse practitioner candidate (ENPC) scope of practice in a Victorian emergency department (ED). The emergency nurse practitioner (ENP) role is relatively new in Victoria and the scope of the ENP(C) practice is yet to be defined. International research literature regarding the ENP role has focused on outcomes such as patient satisfaction, waiting times and/or ED length of stay, accuracy and adequacy of documentation, use of radiography, and patient education, health promotion and communication issues. A prospective exploratory design was used to conduct this cohort study. There were 476 ENPC-managed patients between 14 July 2004 and 31 March 2005 with an average age of 29 years. The majority (77.2%) of ENPC-managed patients were discharged from the ED. The majority of the ENPC time was devoted to clinical practice (55%) and development of clinical practice guidelines (25%). Of patients managed by the ENPC, 49.6% required medications, 51% required diagnostic imaging and 8.6% required pathology testing during their ED stay. The most common discharge referrals were made to local medical officers (73.5%) and the most common referrals made for patients requiring admission were made to the plastic surgery (37.3%) and orthopaedic (35.5%) units. Extensions to the current scope of emergency nursing practice are pivotal to effective management of specific patient groups by ENP. The ENP model of care is an important strategy for the management of increased service demands in Victoria; however, little is known about the scope of the ENPC practice and many outcomes of the ENP care are yet to be defined. Further research to better understand the relationships between ENP outcomes is required if the contribution that ENPs make to emergency care is to be accurately quantified.

Virtual communities of practice for regional small businesses: bringing informal networks online

Virtual communities of practice (VCoPs) are online business networks which are increasingly used by large organisations as a key strategy for creating value in the knowledge-based economy of the 21st Century.This paper examines the applicability of VCoPs to cross-industry regionally clustered small business networks. Interviews conducted with government and industry informants in two regional areas of Australia indicate that these strategies used for establishing VCoPs are applicable to such small business networks. Both regions had regional networks with active member involvement displaying CoP characteristics. Significant social capital existed on which VCoPs could be built, and there were viable alternatives to satisfy the roles of sponsors and leaders. There were, however, significant impediments that will have to be addressed before VCoPs can be  implemented such as the apparent reluctance of many SME owners to use the Internet and ICT generally, and the preference for informal networking. Funding to ensure that VCoPs are sustainable was also an issue. VCoPs appear to be extremely useful in linking small businesses in regional areas and in the development of viable regional clusters.