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.

Southeast Asia: a community of diversity

The region known as the Southeast provides the basis for a broad political community characterized by cultural and ethnic diversity, disparities in economic performance, and differences in regime and constitutional foundations. In recent years, the Association of Southeast Asian Nations (ASEAN) group of nations has made strides toward building a community based on respect for these differences. Despite a growing acceptance for democratic processes and human rights, the influence of these values over existing institutions and state behavior remains incomplete. The future development of the ASEAN region, and the nations that comprise it, is likely to be based on the strength and character of the relationships these states forge with one another and with more powerful external actors.

Sense of community in science fiction random, part 1: Understanding sense of community in an international community of interest

Within the discipline of community psychology there is debate as to the dimensions underlying the construct psychological sense of community (PSOC). One of the few theoretical discussions is that of McMillan and Chavis (1986), who hypothesized four dimensions: Belonging; Fulfillment of Needs; Influence; and Shared Connections. Discussion has also emerged in the literature regarding the role of identification within PSOC. It has been suggested that differences in PSOC may be understood in terms of the degree to which members identify with their community (Fisher & Sonn, 1999). However, few studies have explored the place of identification in PSOC. In addition, while PSOC has been applied to both communities of interest and geographical communities, little research has looked in depth at PSOC within communities of interest. The current study therefore explored PSOC in science fiction fandom, a community of interest with membership from all over the world, by means of a questionnaire distributed at an international science fiction convention (N = 359). In an endeavor to clarify the underlying dimensions of PSOC, the questionnaire included several measures of PSOC, and measures of identification with the community. Results showed that science fiction fandom reported high levels of PSOC. Support emerged for McMillan and Chavis' (1986) four dimensions of PSOC, with the addition of a fifth dimension, that of Conscious Identification. These results, and implications for PSOC research, are discussed.

The potential for communities of practice to underpin the National Training Framework

This report is an evaluation of the sixteen pilot projects that were funded to form Communities of Practice in the VET sector in 2001, as part of the Reframing the Future program. The major theme emerging from this evaluation study is that Communities of Practice in the vocational education and training (VET) sector in Australia have the potential to accelerate, intensify, enrich and enhance the implementation of the national training system.

Communities of enterprise : developing regional SMEs in the knowledge economy

Purpose – This paper proposes the concepts of Communities of Enterprise (CoEs) and Virtual Communities of Enterprise (VCoEs) to describe business networking patterns in regional areas where there is no central organisational or industry focus and small and medium enterprises dominate the economy. Design/methodology/approach – Based on analysis of the literature this paper builds on theoretical understandings of knowledge management, clustering and regional development.
Findings – The concept of CoEs is most appropriate for regional areas characterised by many small enterprises in diverse industries. CoEs enhance development of regional clusters by contributing to their intellectual capital, innovation culture, value networks and social capital. The incorporation of ICT creates VCoEs which provide added potential by enabling regions to expand their learning potential through innovation.
Research limitations/implications – This paper provides a conceptual foundation for empirical research into regional network or cluster development using ICT.
Practical implications – Virtual Communities of Enterprise value creation potential is substantial but only when the socioeconomic elements of regional clusters are understood. The VCoE approach addresses the fact that without an industry focus it can be difficult to engage and link SMEs from different industries, although this is where the greatest potential
for value creation in regional clusters is to be found.
Originality/value – The Virtual Communities of Enterprise (VCoEs) concept specifically addresses the unique requirements of SMEs in regions. It has the potential to provide value for regions in a way few ICT based regional development initiatives have been able to achieve.

Anticipating policy and logics of practice : Australian institutional and academic responses to the globalising "quality research" agenda

Research assessment is now an international trend. This article mobilises a critical policy sociology informed by Bourdieu to unpack the differential effects of research policy shifts in Australia on universities, academics and the field of educational research. It argues in anticipating policy moves - from surveying the logics of practice that have emerged elsewhere from research assessment - that institutional, individual and field responses, while specific to the Australian policy context and mix, have assumed a logic of practice counter productive to "quality" research, education as a field, and equity.