Hospital in the home: constructions of the nursing role - a literature review

• Acute medical and nursing treatment in the home is increasingly seen as an alternative to hospitalization. Models such as hospital in the home (HITH) or acute home care are said to provide a safe, comfortable environment for patients that is conducive to healing.

• A review of the literature reveals the embryonic nature of the research and discussion related to this alternative care delivery model. In general, the benefits of hospital in the home programmes are presented in an uncritical manner.

• Medical practitioners have embraced the move to home care as a means of expanding the use of advanced technologies and improved drug regimes beyond the hospital walls.

• The nursing response has been mechanistic and recipe-like while advancing the HITH nursing role as an opportunity for speciality practice by virtue of the increased autonomy and independence required.

• This review demonstrates the influence of a professional mandate for specialization, and the ideological and scientific interests that have influenced the role of the nurse.

The Digital Divide: Differences in Computer Use between Home and School in Low Socio-economic Households

This article examines information and communication technologies(ICTs) practices in the home and school settings of four disadvantaged families. It reports the findings of a year-long study that investigated the nexus between computer-mediated literacy practices at home and at school and whether this inter-connectivity could make a difference in school success. The findings indicate that there was disjunction between home and school use. The ``digital divide'' exists for the families of this study, not in terms of access but in the gap between ICT practices at home and school. Schools in this study did not integrate ICT skills learned and demonstratedin the home environment into ICT practices at school. The study concludes that constructing pedagogical connections between home and school ICT practices may begin to bridge the ``digital divide''.

Home range of the squirrel glider (Petaurus norfolcensis) in a network of remnant linear habitats

Linear strips of natural or semi-natural vegetation are a characteristic feature of rural landscapes throughout the world. Their value for the conservation of fauna in heavily modified landscapes depends on the response of species to the linear shape of the habitat, and the pressures this imposes on population processes and spatial organization. In south-eastern Australia, woodland habitats occupied by the squirrel glider Petaurus norfolcensis, a threatened species of arboreal marsupial, have been preferentially cleared for agriculture leaving only remnants within cleared farmland. In this study, the home range of P. norfolcensis was investigated by radio-tracking 40 gliders within a highly modified landscape where the majority (83%) of remaining wooded habitat occurs as a network of linear strips along roadsides and streams. Individuals were tracked for one to four seasons, resulting in the collection of 4213 independent locational 'fixes'. All fixes of animals were from remnant woodland. Home ranges were elongated and linear, primarily determined by the shape and arrangement of woodland habitat. Seasonal home ranges were small (mean of 1.4–2.8 ha) and ranged between 320 and 840 m long. Small patches of trees in farmland adjacent to the linear habitats were also extensively used. Despite the highly modified landscape structure, home ranges of P. norfolcensis in the linear network were smaller than those estimated from other studies of this species in continuous habitat. The apparent high quality of the linear habitats is attributed to the density of large old trees, which provide foraging and breeding resources, and the productivity of the environment. Linear landscape elements may have a valuable conservation function where they provide resident habitat or enhance landscape connectivity, but their long-term viability is vulnerable to disturbance.

Multisensory environments for leisure: promoting well-being in nursing home residents with dementia

Multisensory environments such as Snoezelen^® rooms are becoming increasingly popular in health care facilities for older individuals. There is limited reliable evidence of the benefits of such innovations, and the effect they have on residents, caregivers, and visitors in these facilities. This two-stage project examined how effective two types of multisensory environments were in improving the well-being of older individuals with dementia. The two multisensory environments were a Snoezelen room and a landscaped garden. These environments were compared to the experience of the normal living environment. The observed response of 24 residents with dementia in a nursing home was measured during time spent in the Snoezelen room, in the garden, and in the living room. In the second part of the project, face-to-face interviews were conducted with six caregivers and six visitors to obtain their responses to the multisensory environments. These interviews identified the components of the environments most used and enjoyed by residents and the ways in which they could be improved to maximize well-being.

Children's perceptions of their home and neighborhood environments, and their association with objectively measured physical activity: A qualitative and quantitative study

Environmental factors may have an important influence on children’s physical activity, yet children’s perspectives of their home and neighborhood environments have not been widely assessed. The aim of this study was to investigate children’s perceptions of their environments, and to examine associations between these perceptions and objectively measured physical activity. The sample consisted of 147, 10-year-old Australian children, who drew maps of their home and neighborhood environments. A subsample of children photographed places and things in these environments that were important to them. The maps were analyzed for themes, and for the frequency with which particular objects and locations appeared. Physical activity was objectively measured using accelerometers. Six themes emerged from the qualitative analysis of the maps and photographs: the family home; opportunities for physical activity and sedentary pursuits; food items and locations; green space and outside areas; the school and opportunities for social interaction. Of the 11 variables established from these themes, one home and two neighborhood factors were associated with children’s physical activity. These findings contribute to a broader understanding of children’s perceptions of their environment, and highlight the potential importance of the home and neighborhood environments for promoting physical activity behavior.

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.