Silly us! Of course the grid doesn`t work : reading methodologies and policy texts on principals' work

This symposium presents work in progress from an ARC (discovery grant) funded investigation of principal supply, conducted by Jill Blackman, Judyth Sachs and Pat Thomas. Our research goals are to examine claims of an impending shortage of school principals in particular schools and localities, critically evaluate a range of possible reasons for this shortage, and ultimately, through woprk with principals' organisations, to develop some possibilities for policy action. In this symposium we focus on: (1) existing studies of principal supply (2) trends apparent from demographic and employment data, and (3) a text and interview based study of 'human resources' policy. We invite discussion on the implications of this first stage for the next - a national survey and interviews with teachers in pre-service training and in their first years of teaching.

An evidence-based approach to podiatry workforce enhancement and service provision in Western Victoria

Aims & rationale/Objectives : The objectives of this workforce and service enhancement project include: (i) establishing the magnitude of podiatry needs; and (ii) developing a model that can be used to enhance podiatry workforce and podiatry services.
Methods : Surveys to podiatrists and health agencies to determine vacancies, waiting lists, work practices and recruitment methods. Desktop analysis of predictive data for burden of disease and population changes per local government area (LGA). Meetings with podiatrists and their professional association, health care agencies, universities, and Local and State Governments.
Principal findings : Results showed
Long podiatry waiting lists (up to 12 months)
Podiatry vacancies and service gaps
Absence of qualified foot assistants
A high chronic disease burden
A population age mix that is predicted to change dramatically over the next 25 years in favour of those who are 60 years of age or older
Ineffective recruitment methods
The workforce enhancement model that emanated from the meetings with the steering group includes podiatrists as well as auxiliaries such as foot-care assistants who work together in an interprofessional model of care that expands across the region. In addition to training foot-care assistants and the development of a podiatry teaching clinic to enhance student placement, the model builds onto a current continuous professional development program for allied health professionals.
Discussion : Although the allied health workforce (including podiatry) is playing an increasingly important role in the prevention and treatment of chronic diseases, rural areas in particular are disadvantaged by recruitment and retention problems. The podiatry workforce shortage is compounded by ageing populations. Age is associated with increased podiatry usage due to chronic diseases such as diabetes, cardiovascular disease and osteoarthritis.
Implications : A strategic plan developed in consultation with stakeholders aims to improve rural podiatry services in a sustainable manner. The project will be implemented when adequate funding is allocated this year and will be evaluated on its impact on services.
Presentation type : Paper

Training doctors in how to work with interpreters

The medical interpreter's performance can be enhanced if the physician is trained to work effectively with the interpreter. This paper reports on the training of first year medical interns at Southernhealth, a regional network of hospitals in Victoria, Australia. This Commonwealth funded programme was compulsory for all first year doctors. Workshops occurred in the simulator training unit using accident and emergency scenarios. Core teaching material comprised the video and book, Medical Interpreting. Participants were medical interns, qualified telephone medical interpreters, the chief hospital interpreter and the main instructor. Each intern engaged in a simulated role play; observational notes and feedback were recorded. The teaching methodology has demonstrated it to be a programme that skills the physician to work effectively with the medical interpreter. The material and the methodology can be used by interpreters and medical communication specialists to train medical practitioners.

Proposed multi-dimensional approach to evaluating service recovery

Purpose – The purpose of this paper is to extend thinking on service recovery processes and satisfaction with service recovery, using multi-dimensional consumer outcomes. The objective of the work was to propose that satisfaction with service recovery should be based on customers' expectations of the recovery encounter, which would be shaped by their expectations of “non-failed” encounters.

Design/methodology/approach – The paper adopts a theoretical approach. Using the existing service recovery literature as well as the traditional services literature, the conceptual framework and associated research propositions are developed.

Findings – The proposed framework suggests that service recovery is a service encounter it its own right. The effectiveness of recovery encounters will be based on how encounters operate relative to customer expectations and experiences with regard to the recovery activity.

Research limitations/implications – The research propositions and proposed framework need further empirical investigation.

Practical implications – The proposed framework suggests that managing service recovery should be undertaken in a similar fashion to managing any service, and thus managers need to understand customers' recovery expectations. Organisations also need to consider how a recovery action impacts on a range of customer outcomes, as focusing on one aspect will not capture consumers' full set of behaviours.

Originality/value – The proposed model identifies that service recovery should be evaluated with regard to consumers' recovery expectations and satisfaction is not based on expectations with regard to non-failed encounters.

Attitudes about work practices, time allocation and publication output: profiles of U.S. marketing academics

This study examines attitudes of U.S.-based Academy of Marketing Science members toward teaching, research, participation in administration (including service), and academic promotional issues. Individuals were grouped using Ward’s and K-means clustering procedures, which revealed four groups—established academics, research-focused academics, less satisfied midcareer academics, and satisfied teachers. Clusters were further profiled according to the amount of time spent on teaching, research, and administration; research output; and individual demographic and institutional characteristics. Overall, clusters were generally dissatisfied with a range of work-related issues, with workload stress appearing as an issue that needs to be addressed within marketing academia.

Predictors of critical care admission in emergency department patients triaged as low to moderate urgency

Aim. This paper is a report of a study to identify predictors of critical care admission in emergency department patients triaged as low to moderate urgency that may be apparent early in the emergency department episode of care.

Background. Observations of clinical practice show that a number of emergency department patients triaged as low to moderate urgency require critical care admission, raising questions about the relationship between illness severity and physiological status early in the emergency department episode of care.

Methods. A retrospective case control design was used. All participants were aged over 18 years, triaged to Australasian Triage Scale categories 3, 4 or 5, and attended emergency department between 1 July 2004 and 30 June 2005. Cases were admitted to intensive care unit or coronary care unit and controls were admitted to general medical or surgical units. Cases (n = 193) and controls (n = 193) were matched by age, gender, emergency department discharge diagnosis and triage category.

Results. Critical care admission associated with: (i) a presenting complaint of nausea, vomiting and diarrhoea (OR = 3·40, 95%CI:1·22–9·47, P = 0·019), (ii) heart rate abnormalities at triage (OR = 2·10, 95%CI:1·19–3·71, P = 0·011), (iii) temperature abnormalities at triage (OR = 2·87 95%CI:1·05–7·89, P = 0·041), (iv) respiratory rate at first nursing assessment (OR = 1·66, 95%CI:1·05–2·06, P = 0·31) or (v) heart rate abnormalities at first nursing assessment (OR = 1·57, 95%CI = 1·04−2·39, P = 0·033).

Conclusion. Derangements in temperature, respiratory rate and heart appear to increase risk of critical care admission. Further work using a prospective approach is needed to establish which physiological parameters have the highest predictive validity, the level(s) of physiological abnormality with highest clinical utility, and the optimal timing for collection of physiological data.

The career development year : responding to the emergency nursing shortage in Australia

Background: The Career Development Year (CDY) is a 12 month supported entry program at one health care service in Victoria, Australia. The program targets Division One Registered Nurses with little or no emergency nursing experience. The intent of CDY is to improve recruitment to, and retention in, emergency nursing by educational and experiential preparation for emergency nursing practice.

Method: This study used a retrospective exploratory design to examine recruitment and retention of emergency nurses recruited via CDY (n = 72) and compare these findings with recruitment and retention data for a cohort of non-CDY participants (n = 15). CDY data was collected by self-report questionnaires. Descriptive statistics, correlations and inferential statistics were calculated using SPSS.

Results: CDY was found to promote recruitment of novice nurses to emergency nursing, with almost half the respondents (n = 25, 48.1%) reporting they would not have entered emergency nursing were it not for the supported entry program. Further, comparison with non-CDY participants revealed that CDY promoted retention within emergency nursing, with both short-term (n = 47, 90.4% vs. n = 8, 53.4%) and long-term retention doubling (n = 50, 96.1% vs. n = 7, 46.6%) following the introduction of CDY.

Conclusion: CDY was a valuable recruitment tool and successful retention strategy in the ED. Future research using a larger sample may demonstrate potential applicability to other clinical areas.

Shared learning : a collaborative approach for supporting pre-service teacher's reflective practice

Independent learning and critical thought are developed when students are encouraged to express and review their own understandings and the ideas of others as part of their learning journey. This paper focuses on an innovation to engage and support pre-service teachers (students) in a collaborative approach to learning following a teaching practicum. Through the creation of a learning community, information and practice is shared and further challenged in a supportive environment. The opportunity for students to review their own work in relation to responses of peers enables them to become involved in the process of critiquing their own beliefs and practices as well as their peers, within a set framework. Favourable outcomes for both students and university staff augur well for the future development of the process.  

Social work and spirituality in a secular society

• Summary: In an increasingly secular era which finds only a small minority of the population regularly participating in organized religion, there is emerging interest in how spirituality can be incorporated into social work practice. This article proposes one way in which this might occur in `deliberately secular' nations such as Australia.

• Findings: A framework in which spirituality is considered to be an aspect of lived experience is proposed. Dimensions of life which can be incorporated into such a framework include life rituals, creativity, social action, and sense of place.

• Applications : Conceptualizing spirituality in a way which does not use specifically religious language or concepts, may enable discussion of spiritual issues to be incorporated into social work practice when either practitioners or service users have or no religious background or affiliation or no shared religious background.

Housing service officers : agents of the state or customer service officers?

Staff employed in the Victorian Office of Housing are invariably required to exercise discretion in their day-to-day work managing housing assets and providing services to public housing tenants. Policies specify processes but they never cover all situations and do not provide guidance on competing objectives. For example, preparing a property for reletting is a process with protocols and budget constraints. However, staff can make procedural variations that compy with policy. These variations, generally learnt from peers on the job, often result in budget over runs, but do result in improved properties for new tenants. Discretion is being exercised in balancing housing asset, budget control and tenant service objectives. A housing officer sums up the enduring tension in balancing objectives in the question and statement:’ Am I an agent of the state or a customer service officer? Because I can’t be both’. Organisationally these tensions are spoken about as ‘management issues’, ‘policy reengineering’ and ‘unrealistic understandings’. Using data from an ethnographic study in the Victorian Office of Housing, the paper addresses the question: ‘What do we know about the way in which front line housing officers manage competing objectives in their daily work and how might this knowledge be usefully used in the development of operational policy?’ The paper will explore the way in which complex administrative rules are used as a device to align staff to the Office of Housing objectives and limit the exercise of discretion by frontline staff. Against the background of this analysis the paper will consider the limitations of rule making and the extent to which other organisational strategies might be important for improvements in service provision in a context of constrained resources and limited resources.

Defendants' liability for pure mental harm to third parties in Australia : still a work in progress

In Australia, both common and statutory law allows compensation for negligently occasioned recognised psychiatric injury, but distinguishes between pure mental harm and consequential mental harm. This column briefly discusses the concept of pure "mental harm" and the major Australian cases relating to defendants' liability to third parties for causing them pure mental harm (Jaensch v Coffey (1984) 155 CLR 549 [PDF]; Tame v New South Wales; Annetts v Australian Stations Pty Ltd (2002) 211 CLR 317 [PDF]; Sullivan v Moody (2001) 207 CLR 562 [PDF]; and Gifford v Strang Patrick Stevedoring Pty Ltd (2003) 214 CLR 269 [PDF]). The analysis focuses on judicial approaches to determining liability in these cases, especially causation. Lack of guiding principles and precise tests for attribution of liability are illustrated by Kemp v Lyell McEwin Health Service (2006) 96 SASR 192 [PDF]. This case is analysed first in the context of common law, and then in the light of the reform legislation contained in the Civil Liability Act 1936 (SA) and similar provisions in other jurisdictions.

Nursing work and nursing knowledge : exploring the work of women's health nurses, patterns of power and praxis

The majority of women's health nurses in this study work in generalist community health centres. They have developed their praxis within the philosophy and policies of the broader women's health movement and primary health care principles in Australia. The fundamental assumption underlying this study is that women's health nurses possess a unique body of knowledge and clinical wisdom that has not been previously documented and explored. The epistemological base from which these nurses' operate offers important insights into the substantive issues that create and continually shape the practice world of nurses and their clients. Whether this represents a (re)construction of the dominant forms of health care service delivery for women is examined in this study. The study specifically aims at exploring the practice issues and experience of women's health service provision by women's health nurses in the context of the provision of cervical cancer screening services. In mapping this particular group of nurses practice, it sets out to examine the professional and theoretical issues in contemporary nursing and women's health care. In critically analysing the powerful discourses that shape and reshape nursing work, the study raises the concern that previous analyses of pursing work tend to universalise the structural and social subordination of nurses and nursing knowledge. This universalism is most often based on examples of midwifery and nursing work in hospital settings, and subsequently, because of these conceptualisations, all of nursing is too often deemed as a dependent occupation, with little agency, and is analysed as always in relation to medicine, to hospitals, to other knowledge forms. Denoting certain discourses as dominant proposes a relationship of power and knowledge and the thesis argues that all work relations and practices in health are structured by certain power/knowledge relations. This analysis reveals that there IX are many competing and complimentary power/knowledge relations that structure nursing, but that nursing, and in particular women's health nurses, also challenge the power/knowledge relations around them. Through examining theories of power and knowledge the analysis, argues that theoretical eclecticism is necessary to address the complex and varied nature of nursing work. In particular it identifies that postmodern and radical feminist theorising provide the most appropriate framework to further analyse and interpret the work of women's health nurses. Fundamental to the position argued in this thesis is a feminist perspective. This position creates important theoretical and methodological links throughout the whole study. Feminist methodology was employed to guide the design, the collection and the analysis. Intrinsic to this process was the use of the 'voices' of women's health nurses as the basis for theorising. The 'voices' of these nurses are highlighted in the chapters as italicised bold script. A constant companion along the way in examining women's health nurses' work, was the reflexivity with feminist research processes, the theoretical discussions and their 'voices'. Capturing and analysing descriptive accounts of nursing praxis is seen in this thesis as providing a way to theorise about nursing work. This methodology is able to demonstrate the knowledge forms embedded in clinical nursing praxis. Three conceptual threads emerge throughout the discussions: one focuses on nursing praxis as a distinct process, with its own distinct epistemological base rather than in relation to 'other' knowledge forms; another describes the medical restriction and opposition as experienced by this group of nurses, but also of their resistance to medical opposition. The third theme apparent from the interviews, and which was conceptualised as beyond resistance, was the description of the alternative discourses evident in nursing work, and this focused on notions of being a professional and on autonomous nursing praxis. This study concludes that rather than accepting the totalising discourses about nursing there are examples within nursing of resistance—both ideologically and X in practice—to these dominant discourses. Women's health nurses represent an important model of women's health service delivery, an analysis of which can contribute to critically reflecting on the 'paradigm of oppression' cited in nursing and about nursing more generally. Reflecting on women's health service delivery also has relevance in today's policy environment, where structural shifts in Commonwealth/State funding arrangements in community based care, may undermine women's health programs. In summary this study identifies three important propositions for nursing: • nursing praxis can reconstruct traditional models of health care; • nursing praxis is powerful and able to 'resist' dominant discourses; and • nursing praxis can be transformative. Joining feminist perspectives and alternative analyses of power provides a pluralistic and emancipatory politics for viewing, describing and analysing 'other' nursing work. At the micro sites of power and knowledge relations—in the everyday practice worlds of nurses, of negotiation and renegotiation, of work on the margins and at the centre—women's health nurses' praxis operates as a positive, productive and reconstructive force in health care.

Geelong community's priorities and expectations of public health care

Abstract This thesis set out to achieve the following objectives: (1) To identify the priorities and expectations that the Geelong community has of its public health care system. (2) To determine if there is a common view on the attributes of a just health system. (3) To consider a method of utilising the data in the determination of health care priority setting in Barwon Health. (4) To determine a model of community participation which enables ongoing input into the decision making processes of Barwon Health. The methodology involved a combination of qualitative and quantitative research. The qualitative work involved the use of focus groups that were conducted with 64 members of the Geelong community. The issues raised informed the development of the interview schedule that was the basis of the quantitative study, which surveyed a representative sample of 400 members of the Geelong community. Prior to reporting on this work, the areas of distributive justice, scarcity and community participation in health care were considered. The research found that timely access to public hospitals, emergency care and aged care services were the major priorities; for many people, the cost was less relevant than a quality service. Shorter waiting times and increased staffing levels were strongly supported. Increased taxes were nominated as the best means of financing the health system they sought. Community based services were less relevant than hospital services but health education was supported. An egalitarian approach to resource distribution was favoured although the community was prepared to discriminate in favour of younger people and against older people. There was strong support for the community to be involved in decision making in the public health care system through surveys or focus groups but very little support was given to priorities being determined by politicians, administrators and to a lesser extent, medical professionals.