Mental health-related risk factors for violence : using the evidence to guide mental health triage decision making

Mental health clinicians working in emergency crisis assessment teams or mental health triage roles are required to make rapid and accurate risk assessments. The assessment of violence risk at triage is particularly pertinent to the early identification and prevention of patient violence, and to enhancing the safety of clinical staff and the general public. To date, the evidence base for mental health triage violence risk assessment has been minimal. This study aimed to address this evidence gap by identifying best available evidence for mental health-related risk factors for patientinitiated violence.We conducted a systematic review based on the National Health and Medical Research Council of Australia’s methodology for systematic reviews. A total of 6847 studies were retrieved, of which 326 studies met the study inclusion criteria. Of these studies, 277 met inclusion criteria but failed the quality appraisal process, thus a total of 49 studies were included in the final review. The risk factors that achieved the highest evidence grading were predominantly related to dynamic clinical factors immediately observable in the patient’s general appearance, behaviour and speech. These factors included hostility/anger, agitation, thought disturbance, positive symptoms of schizophrenia, suspiciousness and irritability.

Promotional competitions: management decision-making in the Australian consumer marketplace

This research focused on a specific form of sales promotion: promotional competitions. The work identified the processes that organizations applied when defining their marketing strategy and promotional mix, and investigated the decision influences and design considerations which shaped the profile of competitions, offering innovative decision-making models for academics and practitioners.

Simulated jury decision making in online focus groups

Purpose – A significant issue in jury research has been the use of individual jurors to analyse jury decision-making. This paper aimed to examine the applicability of computer-mediated communication to a mock jury deliberation study.

Design/methodology/approach – Groups of three to five Australian residents anonymously attended a secure chat room and participated in a semi-structured discussion about a simulated child sexual assault scenario. Deliberation transcripts were analysed thematically using NVivo. A hermeneutic framework was used to analyse the deliberation transcripts.

Findings – Five interrelated themes were revealed, each reflecting the tools online juries used to communicate, create meaning, and arrive at a verdict. Electronic jury deliberation promoted an understanding of how people make sense of child sexual assault cases in Australia today.

Originality/value – This study advanced the understanding of online decision making in a child sexual assault scenario. It demonstrated that knowledge of how juries deliberate and create meaning could improve our understanding of how verdicts are achieved. Electronic mock juries are a valuable adjunct to traditional jury deliberation studies because they are cost effective, time efficient, and offer wider recruitment opportunities.

Shared decision making: what do clinicians need to know and why should they bother?

Shared decision making enables a clinician and patient to participate jointly in making a health decision, having discussed the options and their benefits and harms, and having considered the patient's values, preferences and circumstances. It is not a single step to be added into a consultation, but a process that can be used to guide decisions about screening, investigations and treatments. The benefits of shared decision making include enabling evidence and patients' preferences to be incorporated into a consultation; improving patient knowledge, risk perception accuracy and patient-clinician communication; and reducing decisional conflict, feeling uninformed and inappropriate use of tests and treatments. Various approaches can be used to guide clinicians through the process. We elaborate on five simple questions that can be used: What will happen if the patient waits and watches? What are the test or treatment options? What are the benefits and harms of each option? How do the benefits and harms weigh up for the patient? Does the patient have enough information to make a choice? Although shared decision making can occur without tools, various types of decision support tools now exist to facilitate it. Misconceptions about shared decision making are hampering its implementation. We address the barriers, as perceived by clinicians. Despite numerous international initiatives to advance shared decision making, very little has occurred in Australia. Consequently, we are lagging behind many other countries and should act urgently.

Sales Promotion Decision Making: Concepts, Principles, and Practice

Up to 74% of marketing budgets can be spent on sales promotions, with manufacturers, suppliers and retailers employing a wide range of incentives from price discounts to complex Omni-channel consumer competitions and contests. Sales promotions are a vital strategic and tactical tool within the marketing value chain and those responsible for campaign planning must negotiate objectives, options and outcomes to ensure their initiatives deliver real results in competitive trading environments. Managers with limited understanding of the principles and practices of sales promotions often rely on past experience or preferences to guide their decision-making. Not surprisingly, without guiding principles, many sales promotions fail to achieve their full potential. This book is a resource for sales promotion professionals looking to improve the effectiveness of their sales promotions. The book is based on an extensive review of over 400 articles and cases. It presents the findings of global research which explores the very DNA of sales promotions, including their role, rationale, nature and function, key decision-making processes and campaign evaluation. Illustrations of sales promotion decision-making in practice based on research conducted in the retail supply chain is also incorporated. This book offers a comprehensive and critical appreciation of the core concepts that underpin sales promotion thinking. The goal is to empower decision-makers, consultants and stakeholders to make confident, informed and effective campaign decisions in the complex field of sales promotions.

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting

 Background: The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions.
Methods: The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health.
Results: In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making.
Conclusions: This study makes an important contribution to understanding how evidence is used within the public health LG context.

Sentencing in child sexual assault cases: factors influencing judicial decision-making

To date, there has been limited examination of variables that influence sentencing in child sexual abuse cases. This study examines the extent to which offence characteristics (such as the number of offences, number and age of victims), the behaviour and perceived credibility of the victim impact upon both sentence length and the setting of earliest parole dates. Analyses conducted using data from 66 adjudicated cases of child sexual assault from the County Court of Victoria, Australia revealed that longer sentences were handed down to offenders who had perpetrated multiple offences, or who had committed offences against younger children. Lower levels of victim credibility were associated with shorter sentences and earlier parole dates for offenders, which were also associated with the presence of more harmful behavioural indicators of abuse. The findings are discussed regarding the importance of presenting evidence about the behaviour of victims following sexual abuse in criminal trials. © 2013 Copyright National Organisation for the Treatment of Abusers.

Evaluating young adult voter decision-making involvement within a compulsory political system

Purpose - This study aims to specifically focus on the lower-involvement young adult voters within the Australian compulsory voting context. It explores voters’ political decision-making by considering the influence of the consumer behaviour theory of involvement. Design/methodology/approach - A thematic analysis was conducted to analyse the interviews within the two research questions: information seeking and decision-making. Findings - Key themes within information seeking are the reach of the information available, the frequency of the information presented, the creativity of the message and one-way versus two-way communication. Key themes within evaluation are promise keeping/trust, achievements or performance and policies. Lower-involvement decision-making has the potential to be a habitual, limited evaluation decision. However, issues of trust, performance and policies may encourage evaluation, thereby reducing the chances of habitually voting for the same party as before. Practical implications - This new area of research has implications for the application of marketing for organisations and political marketing theory. Considering voting decision-making as a lower-involvement decision has implications for assisting the creation and adaptation of strategies to focus on this group of the population. Originality/value - The compulsory voting environment creates a unique situation to study lower-involvement decision-making, as these young adults are less likely to opt out of the voting process. Previous research in political marketing has not specifically explored the application of involvement to young adult voting within a compulsory voting environment.

The decision-making processes adopted by rurally located mandated professionals when child abuse or neglect is suspected

The reporting of suspected child abuse and neglect is a mandated role of medical doctors, nurses, police and teachers in Victoria, Australia. This paper reports on a research study that sought to explicate how mandated professionals working in rural Victorian contexts identify a child/ren at risk and the decisions they make subsequently.

Using smartphones for accountable care and evidence-based decision making in managing gestational diabetes : an Australian case study

Better managing diabetes has become a global priority, especially given the exponential increase in the number of diabetes patients and the financial implications of treating this silent epidemic. In this paper, we focus on how it might be possible to use a mobile technology solution to support and enable superior diabetes monitoring and management. To test this solution, we examined the context of gestational diabetes and adopted a non-blinded randomized control trial with two-arm cross over applied to a private hospital in Victoria, Australia. Further, we use an accountable care system as the theoretical lens and, from this, develop a conceptual framework to bridge evidence-based management with technologies. Theoretically, we unpack McCleallan, McKethan, Lewis, Roski, and Fisher’s (2010) study with our conceptual framework that comprises providers for information (evidence-based management) and technology (smartphone). We enhance Muhlestein, Croshaw, Merrill, Pena, and James’ (2013) accountable care paradigm with three concepts: 1) quality of life, 2) evidence-based management, and 3) affordable care. From the perspective of practice, far-reaching implications have arisen particularly for hospital management pertaining to the cost and quality of care issues. In particular, it appears that adapting mobile technology solutions such as smartphones to support various aspects of care and patient-clinician interactions is a prudent choice to minimize costs and yet provide highquality care.

Assumptions of decision-making capacity: the role supporter attitudes play in the realisation of Article 12 for people with severe or profound intellectual disability

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) was the first legally binding instrument explicitly focused on how human rights apply to people with disability. Amongst their obligations, consistent with the social model of disability, the Convention requires signatory nations to recognise that “…persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life” and mandates signatory nations to develop “…appropriate measures to provide access by persons with disability to the support they may require in exercising their legal capacity”. The Convention promotes supported decision-making as one such measure. Although Australia ratified the UNCRPD in 2008, it retains an interpretative declaration in relation to Article 12 (2, 3, 4), allowing for the use of substituted decision-making in situations where a person is assessed as having no or limited decision-making capacity. Such an outcome is common for people with severe or profound intellectual disability because the assessments they are subjected to are focused on their cognition and generally fail to take into account the interdependent nature of human decision-making. This paper argues that Australia’s interpretative declaration is not in the spirit of the Convention nor the social model of disability on which it is based. It starts from the premise that the intention of Article 12 is to be inclusive of all signatory nations’ citizens, including those with severe or profound cognitive disability. From this premise, arises a practical need to understand how supported decision-making can be used with this group. Drawing from evidence from an empirical study with five people with severe or profound intellectual disability, this paper provides a rare glimpse on what supported decision-making can look like for people with severe or profound intellectual disability. Additionally, it describes the importance of supporters having positive assumptions of decision-making capacity as a factor affecting supported decision-making. This commentary aims to give a focus for practice and policy efforts for ensuring people with severe or profound cognitive disability receive appropriate support in decision-making, a clear obligation of signatory nations of the UNCRPD. A focus on changing supporter attitudes rather than placing the onus of change on people with disability is consistent with the social model of disability, a key driver of the UNCRPD.

The right to supported decision-making for people rarely heard

 This thesis explored supported decision-making for people with severe or profound intellectual disability. The findings provide guidance to supporters and policy makers to assist people with severe or profound intellectual disability to lead maximally autonomous lives, a clear obligation of Australia under the Convention on the Rights of Persons with Disabilities.

Enriching understanding of young adult voter decision-making in the Australian compulsory voting context

This thesis has provided insight into considering how the consumer behaviour theoretical concept of usage impacts on lower-involvement young adult voter decision-making within the Australian compulsory voting context. This differentiated replication of previous research extends the range of results under which decision-making factors hold in voter behaviour.

Clinicians’ perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma

Objective: The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma.Methods: A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews.Results: Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients’ requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer.Conclusions: The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making.

Single-room usage patterns and allocation decision-making in an Australian public hospital: a sequential exploratory study

AIMS AND OBJECTIVES: The aims are to (1) measure occupancy rates of single and shared rooms; (2) compare single room usage patterns and (3) explore the practice, rationale and decision-making processes associated with single rooms; across one Australian public health service.

BACKGROUND: There is a tendency in Australia and internationally to increase the proportion of single patient rooms in hospitals. To date there have been no Australian studies that investigate the use of single rooms in clinical practice.

DESIGN: This study used a sequential exploratory design with data collected in 2014.

METHODS: A descriptive survey was used to measure the use of single rooms across a two-week time frame. Semi-structured interviews were undertaken with occupancy decision-makers to explore the practices, rationale decision-making process associated with single-room allocation.

RESULTS: Total bed occupancy did not fall below 99·4% during the period of data collection. Infection control was the primary reason for patients to be allocated to a single room, however, the patterns varied according to ward type and single-room availability. For occupancy decision-makers, decisions about patient allocation was a complex and challenging process, influenced and complicated by numerous factors including occupancy rates, the infection status of the patient/s, funding and patient/family preference. Bed moves were common resulting from frequent re-evaluation of need.

CONCLUSION: Apart from infection control mandates, there was little tangible evidence to guide decision-making about single-room allocation. Further work is necessary to assist nurses in their decision-making.

RELEVANCE TO CLINICAL PRACTICE: There is a trend towards increasing the proportion of single rooms in new hospital builds. Coupled with the competing clinical demands for single room care, this study highlights the complexity of nursing decision-making about patient allocation to single rooms, an issue urgently requiring further attention.