Paths of professional development in music therapy: training, professional identity and practice

Music therapy is listed as a profession in the EU Regulated Professions Database. This has assisted the next steps towards recognition in relevant countries and regions. The author’s experience as an academic leader in music therapy training over more than two decades is used to reflect on the profession of music therapy within Europe through interrogation of concepts underpinning professional identity, training, and professional practice. Potential tensions between recognition and regulation of healthcare professions are presented and discussed. As all practice takes place in context, balancing training needs between techniques and skills, systemic national and regional policy, and institutional knowledge is crucial. Achieving this balance is not easy but is key to successful growth of practitioner knowledge, seeding student’s curiosity about context and systems from the dawn of training.

Conceptualizing music therapy: five areas that frame the field

New students of music therapy soon find that the most common inquiry about their field of study is “What is music therapy?” They may also be asked questions such as “Does that work?” Even experienced practitioners in the field can find these questions annoyingly routine in meeting new colleagues. In answering these questions, providing a definition of music therapy is important. There are multiple constructs through which the functions and capacities of music therapy can be usefully discussed.

Health service use and costs for infant behaviour problems and maternal stress

AIM: We aim to describe health service (HS) use in the first 6 months post-partum and to examine the associations between service costs, infant behaviour and maternal depressive symptoms. METHODS: Participants were 781 infants and mothers in Melbourne, Australia. Mothers reported infant feeding, sleeping and crying problems, depressive symptoms and health service use. Costs were valued in 2012 Australian dollars. RESULTS: The most common services used were maternal child health nurses, general practitioners (GP) and allied health. Infant feeding problems were associated with increased costs for services relevant to infant behaviour including maternal child health nurses (P = 0.007), GP (P = 0.008) and paediatricians (P = 0.03). Maternal depressive symptoms were associated with increased costs for services relevant to depressive symptoms including parenting centres (P = 0.04), GP (P = 0.004), psychiatrists (P = 0.02) and psychologists (P = 0.001). Mothers who completed high school had higher service costs for infant problems than those with lower education (P = 0.02). Single mothers had higher costs for services used for their depressive symptoms than partnered mothers (P < 0.001). Mothers with English as a second language had lower service costs for their depressive symptoms (P = 0.02). CONCLUSIONS: Infant feeding problems and maternal depressive symptoms are associated with higher costs for health services relevant to these conditions. Cost-effective strategies to manage these conditions are needed with accessibility being ensured for mothers who are experiencing social adversity.

Menopausal stage and age and perceptions of body image

The aim of This study was to investigate the association between menopausal stage and age and women's perception of their body image. Females from a community sample (n = 304. age range from 35 to 65 years) volunteered to complete a structured questionnaire which contained the Multidimensional Body Self Relations Questionnaire (MBSRQ) and the Stunkard Body Shape Figure Scale. One hundred and twenty women were premenopausal, 76 women were perimenopausal and 108 were postmenopausal. The effects of age and menopausal stage could not be separated in ratings of appearance evaluation, fitness evaluation, current, ideal and societal ratings of the Stunkard Body Shape Figure Scale. Premenopausal women (who were likely to be younger) had more positive ratings of appearance evaluation and fitness evaluation than menopausal women (who were likely to be older). Women who were premenopausal nominated smaller figures from the Stunkard Body Shape Figure Scale for ratings of the current, ideal and societal body shape than women who were perimenopausal and postmenopausal. The implications of these findings as they relate to women as they progress through the menopausal transition and as they become older is discussed.

Turning tapes into text: issues surrounding the transcription of interviews

Transcription of interview data is a common practice in qualitative health research. However, there has been little discussion of the techniques of transcription and the issues inherent in the use of transcription as a strategy for managing qualitative data in nursing publications. The process of transcription may disclose or obscure certain information. Researchers need to question practices of transcription that have been taken for granted and make transparent the processes used to preserve the integrity of data. This paper first examines research reported in nursing and allied health journals employing interviews for data collection and the attention given to the transcription phase. It then deals with issues of concern regarding the transcription of interviews, and offers suggestions for promoting validity.

Community Care in Australia

Access and equity are guiding principles for community care in Australia. Community care in Australia is universally provided through Australia's Medicare system, which assures all people access to needed services. The largest community care system, the Home and Community Care Program (HACC), serves frail older and disabled people. The HACC program is undergoing steady reform to provide more seamless transitions of care for people from home care to residential care whether permanent or for respite purposes. Community health services provide a wide range of center-based and outreach services that any person may access and that are provided on the basis of need. Nevertheless, pressures for greater privatization of services cause tensions, and access is jeopardized further by shortages, particularly in rural areas, of aged care nurses, allied health personnel, and medical practitioners.

Outsourcing and benchmarking in a rural public hospital : does economic theory provide the complete answer?

INTRODUCTION: The ideology and pronouncements of the Australian Government in introducing 'competitive neutrality' to the public sector has improved efficiency and resource usage. In the health sector, the Human Services Department directed that non-clinical and clinical areas be market tested through benchmarking services against the private sector, with the possibility of outsourcing. These services included car parking, computing, laundry, engineering, cleaning, catering, medical imaging (radiology), pathology, pharmacy, allied health and general practice. Managers, when they choose between outsourcing, and internal servicing and production, would thus ideally base their decision on economic principles. Williamson's transaction cost theory studies the governance mechanisms that can be used to achieve economic efficiency and proposes that the optimal organisation structure is that which minimises transaction costs or the costs of exchange. Williamson proposes that four variables will affect such costs, namely: (i) frequency of exchange; (ii) asset specificity; (iii) environmental uncertainty; and (iv) threat of opportunism. This paper provides evidence from a rural public hospital and examines whether Williamson's transaction cost theory is applicable. d into an analysis that relies solely on transaction

Do clinicians know how to use pulse oximetry? A literature review and clinical implications

Pulse oximerry has become one of the most commonly used tools in the clinical environment for assessing patients' oxygenation status. It is employed almost continuously in critical care areas and frequently in the general ward environment. Although it is a much better tool for determining hypoxia than the human eye, its use is limited if clinicians do not understand relevant physiological principles, such as the oxyhaemoglobin dissociation curve and the inherent limitations of the device. Furthermore, the risk for compromised patient safety is significant if clinicians fail to recognise the potential for false or erroneous readings. This paper explores the research which has examined clinicians' comprehension of pulse oximetry. Fourteen studies examining clinicians' knowledge of pulse oximerry were reviewed. These studies revealed significant knowledge deficits about pulse oximerry amongst nurses, doctors and allied health professionals, all of whom used this technology frequently. Alarmingly, those lacking an adequate understanding of pulse oximerry included senior, experienced clinicians. The studies were limited by their use of convenience sampling and small sample sizes. Further research is needed to better understand the significance of this problem and to examine how principles of pulse oximerry are taught to nurses and other health professionals at the undergraduate and postgraduate levels. Educators and clinicians alike must ensure that a safe level of knowledge for the use of pulse oximerry is maintained in order to ensure that patient outcomes are not compromised.

Knowledge, risk perceptions and condom usage in male sex workers from three Australian cities

The study identifies factors associated with knowledge and perception of risk of HIV/AIDS, as well as attitudes to and usage of condoms by a sample of male sex workers (MSW). One hundred and eighty-five male sex workers completed a self-reported questionnaire, including knowledge about HIV transmission, attitudes to condom use and perceptions and personal susceptibility to HIV and sexually transmitted infection (STI) risk, and a two-week diary recording use of condom during commercial sex encounters. The findings reveal that condom use was found in 77.7% of the encounters with clients and the majority of the respondents perceived themselves to be at no risk for HIV because of sex work. Independent sex workers from Melbourne and workers who owned their place of residence used condoms in a significant lower proportion. Generally speaking, knowledge about the risks associated with AIDS was high, with respondents showing lower knowledge about the risks associated with unprotected receptive or active oral sex. Participants held a positive attitude to condom use; most considered the provisions of condoms to be their responsibility rather than clients; and they were more worried about contracting an STI than HIV. Those who scored higher on the knowledge scale had more positive attitudes to condom use and those who had a more positive attitude to condom use recorded a perceived lower risk of contracting STI but not HIV. The study discusses the relevance of these findings for public health risk reduction and sexual health education campaigns.

Alcohol and drug use in Australian male sex workers: its relationship to the safety outcome of the sex encounter

This paper describes the self-reporting patterns of alcohol and drug consumption among male sex workers (MSWs) in three Australian cities during commercial sex encounters, and examines to what extent alcohol and drugs are used and whether this is related to the safe/unsafe outcome of the commercial sex encounter. One hundred and eighty-six MSWs from Brisbane, Sydney and Melbourne completed a diary following each commercial sex encounter over a two-week period. MSWs reported 2,087 commercial sex encounters during the study period. Alcohol or drug consumption was reported in 50.5% of the encounters.

A method for the quantitative analysis of the layering of HIV-related stigma

HIV-related stigma is regarded as one of the major barriers in the development of effective prevention and care programs; but the stigma associated with HIV stigma is not a singular entity. The stigma of the infection is layered with other stigmas, such as those associated with the routes of transmission (e.g., sex work and injecting drug use) and personal characteristics (e.g., race, religion, ethnicity and gender). In developing programs and policies to overcome HIV-related stigma, cognisance needs to be taken of all the sources of stigma, and how they may interact. A novel method is described for examining the layers of HIV/AIDS-related stigma, and secondary data are adapted to illustrate this. The importance of understanding the layering of stigma for the development of effective interventions is also discussed.

HIV discrimination : integrating the results from a six-country situational anaylsis in the Asia Pacific

The findings of the six independent studies on institutional forms of HIV discrimination in the Asia Pacific presented in this Special Issue of AIDS Care are integrated. At first glance, the general pattern of the results across the study sites suggests that discrimination is most pertinent in the domain of 'practice' rather than in the domains of law or institutional policy. On closer analysis, however, utilising the qualitative data, this conclusion does not take sufficient account of the cultural context within which the interpersonal interaction (practice) between the health carers and people living with HIV/AIDS occurs. Limitations on the use of anti-discrimination legislations and protective written policies for reducing discrimination in these contexts are discussed. The need for alternative approaches to thinking about discrimination intervention is raised and this is done through a consideration of the strategy of universal precautions.

An Asia Pacific six-country study on HIV-related discrimination : introduction

This paper outlines a six-country study of institutionalised forms of HIV/AIDS-related discrimination in the Asia-Pacific region. Although recognised as a barrier to disease prevention and treatment, very limited data are available on the effects of institutionalised HIV-related stigma and discrimination. Understanding the forms of discrimination within the institutions where they occur is the first step to identifying effective ways of promoting compassionate, non-discriminatory treatment of PLWHA. Thus, the goal of this research project was to document institutional discrimination against PLWHA, as guided by the UNAIDS Protocol for the Identification of Discrimination Against People Living with HIV (2000), in six Asian countries: India, Thailand, Philippines, China, Vietnam and Indonesia. As a precursor to the six individual studies, this paper provides a brief overview of the literature on HIV discrimination, and then describes the UNAIDS Protocol and the shared methodological considerations relevant to all of the study sites. Commonalities in sampling, procedures and analysis are also discussed.

A rural model for delivering regional continuing nurse education by videoconference : a pilot project

Background : The South West Alliance of Rural Health (SWARH) is an alliance of 33 health care agencies scattered across South West Victoria over a total area of approximately 46 000 square kilometres. SWARH was established to develop and install information technology (IT) infrastructure, hardware and software for all acute public hospitals in the region. The Rural Intercampus Learning Environment Project (March 2003-March 2004) piloted the use of the SWARH regional area IT network to deliver a program of continuing education to Division 1 registered nurses, utilising the expertise of local health professionals. The study was funded by the Department of Human Services, Victoria.

Aims & rationale/Objectives : Establish partnerships for multi-site delivery of programs.
Develop existing educational programs and resources for video and intranet delivery (including IT training and change management).
Collaboratively deliver educational programs utilising SWARHnet to six rural sites.
Explore issues related to the use of the technology in continuing education for rural nurses and the implications for practice.

Methods : Key informant interviews, paper-based audits, and focus groups informed the development of the schedule of the program. Session participants completed a 2-page evaluation questionnaire.

Principal findings : Participants must own the process.
Videoconferencing should be considered an adjunct to traditional education programs.
Videoconferencing most suitable for short education sessions as opposed to full-day workshops.
IT problems are unpredictable and frustrating for all concerned.
IT awareness/training of staff is essential.

Implications : The project proposes a model for coordinating and delivering regional continuing education which has been shown to improve access to education programs across multiple sites. It provides a sustainable organisational framework for the program, which could be applied in continuing professional education programs of other rural health professions, such as dentistry, medicine, allied health and pharmacy.

Presentation type : Poster