Sedation and analgesia management for mechanically ventilated adults: literature review, case study and recommentations for practice.

The quality of sedation management in mechanically ventilated patients has been a source of concern in recent years. This paper summarises the literature on the principles of optimal sedation, discusses the consequences of over and undersedation, highlighting the importance of appropriate pain management, and presents a case study using the results of an audit of 48 mechanically ventilated adults. As a result of the review and audit, we are implementing changes to practice.

The most important recommendations from the literature are the use of a sedation scale, setting of a goal sedation score, appropriate pain management and implementation of a nurse initiated sedation algorithm. Other recommendations include use of bolus rather than continuous sedative infusions and recommencing regular medications for anxiety, depression and other phychiatric disorders as soon as possible. A recommendation arising from our audit was the need to identify patients at high risk of oversedation and undersedation and adopt a proactive rather than reactive approach to management. The practice goal is to provide adequate and appropriate analgesia and anxiolysis for patients. This will improve patient comfort while reducing length of mechanical ventilation and minimising risk of complications.

Limitations of market driven sustainability : the case of environmental management systems for food production in Australia

Environmental Management Systems (EMSs) address environmental risks in supply chains and certification of environmental claims. Governments supporting EMSs have encouraged producers to respond to anticipated consumer environmental concerns. Attempts at implementing EMSs have rarely been in direct response to market demand but are usually farmer organisation driven – to forestall increased regulation. In Australia, consumer demand for foods produced to environmentally sustainable standards is minimal because consumers don’t believe these products offer special benefits. EMS implementation is expensive and onerous; and the products require a market premium. Food consumers have difficulty differentiating the terms organic, environmentally-friendly, and sustainably-produced in food labelling.

Management of power line easement vegetation for small mammal conservation in Australia : a case study of the broad-toothed rat (Mastacomys fuscus)

Within Australia, very little attention has been given to the potential biodiversity benefits of power line easements, if ecologically sensitive management regimes are developed. This study examined the potential power line easements may have for the conservation of small mammals, and in particular the near threatened, Broad-toothed Rat Mastacomys fuscus, in Australia. Easement vegetation was found to support a diverse small mammal community, including M. fuscus if the vegetation was allowed to develop some structural complexity. M. fuscus was one of the first species to recolonize the easement habitat, provided that the areas had regenerated to a sufficient level. Results suggests; however, that the current management technique used, where the entire easement is managed at one time via mass slashing, on short rotation times, is most likely limiting M. fuscus to low abundances, and causing isolation of the current M. fuscus populations. To ensure that power line easements supply functional, usable habitat for small mammals and other species and to minimize their potential to fragment small mammal populations, it is recommended that current management techniques be reassessed. In an effort to develop more appropriate management regimes, it was recommended that rotation times be increased between management, that mass slashing of the easement at one time be reassessed, especially in naturally low growing areas and that rotational type slashing be implemented. Other techniques such as spot spraying, may be all that is needed within some areas to control emergent saplings. This study highlights that potential biodiversity values do exist for Australian power line easements, if some changes occur to the current management practices.

Entering China : an operations management case study

Market forces and international competition are driving companies to reduce costs. The operations management issues experienced by 50 Australian companies when investing in China were examined. Many experiences were found to be common to most of the participant's industries. Relationships with government, associations, local partners and members of supply chains were considered highly important. Levels of technology in China were not considered to be a significant issue. Access to staff with sufficient technology training (particularly for product development) and technology implementation was an important issue. The paper presents a model relating the various operations management issues identified to one another.

The dual technique model within case study approaches to cross-cultural management research in China

This paper advocates the effectiveness of a dual technique model of interviewing, which combines narrative and depth interview techniques, within the case study method in a cross-cultural management research setting, an Australian MNC operating in China. The case study is acknowledged to be a highly appropriate method for gaining insight into the complicated area of cross-cultural management enquiry in order to generate new theories. In this context, we propose a model which combines the narrative and the depth interview techniques in the interview process, and have illustrated its usefulness with material drawn from the China-Australia cross-cultural research interface.

After establishing the rationale for the model, the discussion focuses on the practicalities of applying it in interviews, in relation to the preparation, warm-up and trust building phases, and in the exercise of personal interviewing skills in cross-cultural research, in this case, the advantage of the interviewer being bilingual.

Tennis Australia : a case study of financial management for sport development at the club level

There has been substantial work that examines financial management in professional sport which has assisted scholars and practitioners to better understand processes and policies to ensure teams and leagues are sustainable (Andreff & Staudohar, 2000; Howard & Crompton, 2004; Kraekel, 2007; Lewis, Sexton, & Lock, 2007; Li, Hofacre, & Mahony, 2001). However, there has been a paucity of scholarly research that examines financial management at the grass roots levels of sport, and how this integrates with national sport organisation strategic planning, with the exception of the recent work by Havaris and Danylchuk (2007). This study aims to add to this gap in knowledge by examining financial management at the club level of tennis in Australia.

Place-based knowledge networks : the case of water management in South-West Victoria, Australia

This article aims to investigate the need for effective exchanges between knowledge generators and knowledge users in water management. Firstly, we explore the use of adaptive management for water governance and then outline the communication issues of water-management knowledge at a regional scale. Central to this approach is the need to harness 'local' knowledge that can be used to develop community participation in local water governance. Accordingly, we propose a three-network communication model to illustrate the process and identify the issues of concern for developing place-based strategies. Since research plays a central role in knowledge generation, one of the first ways to proceed is to recognise local research and incorporate it into an inclusive decision-making process. One way to achieve this is through the development of regional networks that are openly available to all, and we explore this by focusing on the place of 'network thinking' at local scale using a newly developed regional network for local knowledge dissemination in south-west Victoria, Australia. We conclude that so far this new network is too heavily reliant upon one web-based tool and outline a broader range of strategies that can be used to achieve its aims.

Moving beyond resistance to restraint minimization : a case study of change management in aged care

Aim: This case study describes a quality initiative to minimize restraint in an Australian residential aged care facility.

Approach: The process of improving practice is examined with reference to the literature on implementation of research into practice and change management. The differences between planned and emergent approaches to change management are discussed. The concepts of resistance and attractors are explored in relation to our experiences of managing the change process in this initiative. The importance of the interpersonal interactions that were involved in facilitating the change process is highlighted.

Implications: Recommendations are offered for dealing with change management processes in clinical environments, particularly the need to move beyond an individual mind-set to a systems-based approach for quality initiatives in residential aged care.

Stimulating vertical integration in coastal management in a federated nation: The case of Australian coastal policy reform.

Four decades ago Australia was credited as being an early leader in  implementing integrated coastal management (ICM). Nevertheless, as a  federation of states and territories Australia has since struggled to fully  implement vertical integration of its coastal governance arrangements. In particular the federal government has historically possessed only a minor role in coastal management despite the recommendations of several major inquires suggesting that this role needed to be enhanced. This article examines a series of circumstances and events over the past two years in Australia that has created the opportunity for the federal government to adopt a more significant and prominent role in coastal management and hence to substantially complete the vertical integration of ICM in Australia. These stimuli for coastal policy reform could also play a role in enhancing ICM in other federated nations.

Using competencies in human resource management : case studies in Australian companies

This study investigated the use of competencies for human resource management in seven Australian companies. Despite advocacy for the use of competencies by Government Committees and Task Forces (For example Carmichael (1992), Mayer, (1992) and Karpin, 1995), and the existence of competency standards for eighty per cent of the Australian workforce, the competency approach has not been widely adopted. A review of the literature indicated that the term competency had several meanings with different implications for its use depending on the meaning. The study looked at how individuals have defined the term and applied the approach to human resource management practices. Interviews were conducted with Human Resource and Training managers, and operative staff in companies using competencies. How they defined the term, described the rationale for using competencies, and applied competencies to selection, training, performance appraisal and remuneration were determined. Case studies were written for each company to describe their particular application of competencies. Competencies were found to be defined in several ways by those interviewed. Some advantages of using competencies in human resource management applications were found. The amount of work involved in introducing the competency approach was described as a reason why competencies have not been more widely adopted.

Performing arts management in a climate of adjustment : case studies from Vietnam and Australia

This paper presents a series of empirical case studies to discuss impacts of economic globalisation on the development of performing arts organisations in Vietnam (Hanoi Youth Theatre and Vietnam National Symphony Orchestra) and Australia (Melbourne Theatre Company and Sydney Symphony Orchestra), and focuses on how Vietnamese organisations have adapted to these changes. The paper also identifies cultural policy implications for the development of the sector; for arts management training in Vietnam so that the sector (and more importantly, the artists) may fully benefit from the open market context. The findings indicate that Vietnamese performing arts organisations have attempted to adapt to the new market context while struggling to balance artistic quality, freedom and financial viability in the new socialist regime. The Australian case studies offered a relevant management model to Vietnamese arts management practice and training.