Ethical challenges associated with providing continence care in residential aged care facilities : findings from a grounded theory study

A person-centred approach to care in residential aged care facilities should uphold residents’ rights to independence, choice, decision-making, participation, and control over their lifestyle. Little is known about how nurses and personal care assistants working in these facilities uphold these ideals when assisting residents maintain continence and manage incontinence. The overall aim of the study was to develop a grounded theory to describe and explain how Australian residents of aged care facilities have their continence care needs determined, delivered and communicated. This paper presents and discusses a subset of the findings about the ethical challenges nurses and personal care assistants encountered whilst providing continence care. Grounded theory methodology was used for in-depth interviews with 18 nurses and personal care assistants who had experience of providing, supervising or assessing continence care in any Australian residential aged care facility, and to analyse 88 hours of field observations in two facilities. Data generation and analysis occurred simultaneously using open coding, theoretical coding, and selective coding, until data were saturated. While addressing the day-to-day needs of residents who needed help to maintain continence and/or manage incontinence, nurses and personal care assistants struggled to enable residents to exercise choice and autonomy. The main factor that contributed to this problem was that the fact that nurses and personal care assistants had to respond to multiple, competing, and conflicting expectations about residents’ care needs. This situation was compounded by workforce constraints, inadequate information about residents’ care needs, and an unpredictable work environment. Providing continence care accentuated the ethical tensions associated with caregiving. Nurses’ and personal care assistants’ responses were mainly characterised by highly protective behaviours towards residents. Underlying structural factors that hinder high quality continence care to residents of aged care facilities should be urgently addressed.

Understanding feedback report uptake: process evaluation findings from a 13-month feedback intervention in long-term care settings

BACKGROUND: Long-term care settings provide care to a large proportion of predominantly older, highly disabled adults across the United States and Canada. Managing and improving quality of care is challenging, in part because staffing is highly dependent on relatively non-professional health care aides and resources are limited. Feedback interventions in these settings are relatively rare, and there has been little published information about the process of feedback intervention. Our objectives were to describe the key components of uptake of the feedback reports, as well as other indicators of participant response to the intervention. METHODS: We conducted this project in nine long-term care units in four facilities in Edmonton, Canada. We used mixed methods, including observations during a 13-month feedback report intervention with nine post-feedback survey cycles, to conduct a process evaluation of a feedback report intervention in these units. We included all facility-based direct care providers (staff) in the feedback report distribution and survey administration. We conducted descriptive analyses of the data from observations and surveys, presenting this in tabular and graphic form. We constructed a short scale to measure uptake of the feedback reports. Our analysis evaluated feedback report uptake by provider type over the 13 months of the intervention. RESULTS: We received a total of 1,080 survey responses over the period of the intervention, which varied by type of provider, facility, and survey month. Total number of reports distributed ranged from 103 in cycle 12 to 229 in cycle 3, although the method of delivery varied widely across the period, from 12% to 65% delivered directly to individuals and 15% to 84% left for later distribution. The key elements of feedback uptake, including receiving, reading, understanding, discussing, and reporting a perception that the reports were useful, varied by survey cycle and provider type, as well as by facility. Uptake, as we measured it, was consistently high overall, but varied widely by provider type and time period. CONCLUSIONS: We report detailed process data describing the aspects of uptake of a feedback report during an intensive, longitudinal feedback intervention in long-term care facilities. Uptake is a complex process for which we used multiple measures. We demonstrate the feasibility of conducting a complex longitudinal feedback intervention in relatively resource-poor long-term care facilities to a wider range of provider types than have been included in prior feedback interventions.

Organizational factors related to the confidence of workers in working with residents with dementia or depression in aged care facilities

OBJECTIVES: There has been limited research examining how organizational factors are associated with the level of confidence of residential aged care staff in managing both residents' depression and the behavioural and psychological symptoms of residents with dementia (BPSD). This study investigated this issue. METHOD: A cross-sectional study design was employed. In total, 255 aged care staff (131 senior staff, 124 junior staff) from 21 residential care facilities participated in the study. All staff completed measures of self-efficacy in managing BPSD as well as confidence in working with older people with depression. They also completed measures of organizational climate (autonomy, cohesion, trust, pressure, support, recognition, fairness and encouragement of innovation) and measures of workplace experience (job role, number of years working in aged care facilities), job stress and satisfaction, and knowledge of depression. RESULTS: The results demonstrated that autonomy, trust, support, and job stress were associated with confidence in managing BPSD, while the factors related to confidence in managing depression were autonomy, support, job stress, job satisfaction, and knowledge of depression. CONCLUSION: These findings highlight that organizational climate factors need to be addressed in order to increase staff confidence in managing BPSD and depression. In particular, the findings demonstrate the importance of fostering organizational environments in which autonomy is promoted and there is support and cooperation among aged care staff. Attention to these factors is likely to increase the confidence of staff as they carry out their carer role.

Predictors of academic performance of nursing and paramedic students in first year bioscience

The expanding scope of practice of paramedics and nurses demands they possess a sophisticated knowledge of bioscience to enable them to think critically and make rational clinical decisions. It is well documented that nursing students struggle with bioscience but there are no studies examining the performance of paramedic students in this crucial subject. In this study, we compared the academic performance of first year nursing, paramedic and nursing/paramedic double degree students in a bioscience subject. Regression analyses were used to identify predictors of academic success. Data revealed a low success rate in bioscience for all three degree programs (63.2, 58.8, and 67.6% respectively) and a strong correlation between academic success in bioscience and non-bioscience subjects (r(2)=0.49). The best predictors of overall academic success were the University Admission Index score and mature entry into the course. Previous study of biology was associated with an increased bioscience and overall GPA but not with non-bioscience grades. Discriminant analysis was used to develop a model that could predict overall academic success with an accuracy of 78.5%. These criteria may be useful during the admission process and for the early identification of students at risk of failure.

Recognising and responding to 'cutting corners' when providing nursing care: a qualitative study

AIMS AND OBJECTIVES: The aim of this study is to report on a key finding of a larger study investigating the 'gaps' in patient care that registered nurses encounter during the course of their practice. A key finding of this larger study was that 'cutting corners' was a gap discerned by nurses. BACKGROUND: 'Cutting corners' has been characterised as a 'violation' and threat to patient safety, although there is a paucity of research on this issue. DESIGN: Naturalistic inquiry using a qualitative exploratory descriptive approach. METHODS: Data were collected from a purposeful sample of 71 registered nurses from emergency department, critical care, perioperative, rehabilitation and transitional care and neurosciences settings in Australia and analysed using content and thematic analysis strategies. RESULTS: Cutting corners was a common practice that encompassed (1) the partial or complete omission of patient care, (2) delays in providing care and (3) the failure to do things correctly. Corners were cut in patient assessment, essential nursing care, the care of central venous catheters and medication administration. The practice of cutting corners was perceived as contributing to preventable adverse events. CONCLUSIONS: The study found that cutting corners created gaps that contributed to unfinished nursing care and preventable adverse events. The findings of the study raise the possibility that cutting corners is a salient but underinvestigated characteristic of nursing practice. Further research and inquiry are needed to deepen understanding of cutting corners and its impact on patient safety. RELEVANCE TO CLINICAL PRACTICE: Identifying the nature and implications of cutting corners when providing nursing care is an important contributing factor to improving patient safety and quality care.

Chalk and cheese: Grounded theory case studies of the introduction and usage of activity-based information in two British banks

During the conduct of a research project into influences on the use of management accounting information, the use of activity-based techniques and information in two British banks was studied by the application of grounded theory principles. Juxtaposition of these two case studies reveals insights about the managers' significantly different experiences of ongoing applications, and the different outcomes of implementation that may arise, despite commonality in the organization and industry environment. This paper presents these two case studies, highlights the similarities and differences between them, and draws some conclusions about the causes of the differences. Factors that can be managed to achieve a greater use of these particular management accounting techniques, and the information they generate, are revealed. In particular, the findings suggest that the introduction of transfer charging between the bank's internal units highlights the need for activity-based techniques, and that education, communication and implementor support are vital, both for implementation success and for the widespread continuing use of the resultant applications. Further, between the two cases the greatest consensus was found in a common concern about the amount of detail in the databank and reports.

Using environmental interventions to create sustainable solutions to problems to health and wellbeing

Recent research by Deakin University, in collaboration with Parks Victoria and its Strategic Partners, indicates that contact with nature may promote human health and wellbeing. International research indicates that simply viewing a natural scene or watching wildlife reduces stress and tension, improves concentration, remedies mental fatigue, boosts immunity, and enhances psychological health. This is aside from any physical health benefits flowing from reduced stress, increased exercise and improved air quality when contact with nature involves activities in natural environments. The literature suggests that interacting with nature through gardening or having a companion animal is also beneficial for health, and where these activities involve contact with other humans, might extend benefits beyond the individual to the community, through enhanced social capital. This paper sets out the potential scope of work flowing from the initial research, in terms of target groups, research foci, intervention strategies, and likely benefits, and reports on progress in establishing a program of Australian,based empirical research. It proposes the establishment of alliances between researchers and practitioners in a range of disciplines (including environmental health) to ensure that the links between contact with nature and human health and wellbeing are explored and expressed in ways that are both beneficial and sustainable.

Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice

Postoperative pulmonary complications are the most frequent and significant contributor to morbidity, mortality, and costs associated with hospitalization. Interestingly, despite the prevalence of these complications in cardiac surgical patients, recognition, diagnosis, and management of this problem vary widely. In addition, little information is available on the continuum between routine postoperative pulmonary dysfunction and postoperative pulmonary complications. The course of events from pulmonary dysfunction associated with surgery to discharge from the hospital in cardiac patients is largely unexplored. In the absence of evidence-based practice guidelines for the care of cardiac surgical patients with postoperative pulmonary dysfunction, an understanding of the path ophysiological basis of the development of postoperative pulmonary complications is fundamental to enable clinicians to assess the value of current management interventions. Previous research on postoperative pulmonary dysfunction in adults undergoing cardiac surgery is reviewed, with an emphasis on the pathogenesis of this problem, implications for clinical nursing practice, and possibilities for future research.

Tongan and European children`s interactions at home in urban New Zealand

Three- and four-year-old children have a range of culturally specific opportunities to develop social skills at home. In culturally diverse environments such as New Zealand, interplay between ethnic group, caregivers' expectations, and children's home interactions is important because different cultural groups share common educational and health systems. In this exploratory study, we compared three and four-year-old children's interactions with adults and older siblings in Tongan (N = 5) and European (N = 5) families who had lived in urban New Zealand for one to five generations. Adults' ideas of appropriate behaviors for their young children provided the basis for interpreting quantitative data obtained from counts of selected verbal and nonverbal behaviors, and measures of children's active involvement in their interactions. Tongan children had similar patterns of interaction with adults and older siblings. European children were more verbal and tended to elicit more ongoing interactions with adults versus siblings. We also compared the interactions of Tongan and European children directly. European children's interactions with adults were more verbal than those of Tongan children. European children were more successful at achieving ongoing interactions with adults. These cultural differences reflected caregivers' ideas of child-appropriate behavior. While all children demonstrated social skills that were important in their respective homes and communities, European children had more opportunities to develop patterns of child–adult interaction that are rewarded in New Zealand schools.

Developing and testing a model of knowledge utilisation through marketing research

Little research has examined the return on marketing research, be that financial or knowledge acquisition. Furthermore, there has been insufficient research into the factors affecting the conduct of marketing research. This paper investigates and reports on a conceptual model proposed by Yaman (2000), which explores knowledge acquisition, dissemination, and utilisation through marketing research. The study specifically explores and attempts to replicate the model’s conceptual structure. The data were collected electronically via emails and an HTML web-form questionnaire, with a sample of 182 being obtained. Using structural equation modelling, the results obtained indicated an adequate fit for a modified Yaman model to the data from this particular sample.

Stakeholder and gender characteristics of mining and energy IPO boards of directors

The mining and energy sectors are particularly publicly sensitive sectors and subject to a high degree of public scrutiny. Evan and Freeman (1993) suggest that such public scrutiny needs may be better met by having direct public stakeholder representation on the board of directors. Similarly, Bilimoria (2000) argues a strong commercial case for engaging women on boards. This paper investigates the number and proportion of non equity holding public stakeholder directors and the number and proportion of women directors on the boards of Australian mining and energy company initial public offerings (IPOs) and reports a paucity of public stakeholder directors and also a low proportional female representation on such IPO boards.

Business ethics in TQM : the qualities and spectrum zones of a case illustration

Purpose - The objective of this research is to introduce and describe a conceptual framework of business ethics in TQM.

Design/methodology/approach - In order to highlight the concepts proffered, a case study in the Swedish retail industry was conducted. The data that underpin the case illustration have been collected as part of a larger research project in the Swedish retail industry. Draws on and reports the findings from one case of the larger research project that has been used in this instance to inform the role of business ethics in TQM. The case illustration is based on a qualitative approach. The data were collected through interviews with leading executives in the corporation,

Findings - Both time and context become crucial parameters to manage the quality and spectrum zones of core values in the marketplace. In fact, the necessary quality management of business operations has to be performed without delay, minimising the damage. Therefore, the importance of business ethics becomes evident in TQM. In the long run, TQM will not succeed in business operations unless business ethics is considered in the core values to support the techniques and tools applied.

Research limitations/implications - The model has only been tested by relating it to one case in the Swedish retail industry.

Practical implications - TQM is dependent on the contextual and evolutionary issues in the marketplace. Therefore, TQM should be interpreted as a continuous process. The importance of continuously monitoring the spectrum zones and qualities of core values in TQM should not be under-estimated. Therefore, business ethics should always be present in TQM. Further research would benefit from other case studies of how business ethics benefits TQM. Therefore, the dynamics of business ethics in TQM should be further explored.

Originality/value - Business ethics needs to be an essential consideration of any TQM process. Examines how an organization can incorporate this task.

Talent identification and risk management at AFL clubs : 'We'll only recruit public school boys in the future'

This paper will report on a research project funded by the Australian Football League (AFL).The research mobilises Foucault's later work on the care of the Self to focus on the ways in which player identities are regulated; and the manner in which players conduct themselves in ways that can be characterised as professional - or not.

The paper explores the forms of risk management that Clubs use in the processes of talent identification that they engage in as a consequence of AFL rules. The paper discusses how psychological profiling is used to identify character traits prior to initial recruitment in the draft or trading processes - and reports on suggestions that risk management in this increasingly commerciaIised context may lead to recruitment practices that exclude certain types of persons. from
certain types of backgrounds.

Modelling regular and estimable inverse demand systems : a distance function approach

To be useful for policy simulation in the current climate of rapid structural change, inverse demand systems must remain regular over substanstial variations in quantities. The distance function is a convenient vehicle for generating such systems. It also allows convenient imposition of prior ideas about the structure of preferences required for realistic policy work. While the distance function directly yields Hicksian inverse demand functions via the Shepard-Hanoch lemma, they are usually explicit in the unobservable level of utility (u), but lack a closed-form representation in terms of the observable variables. Note however that the unobservability of u need not hinder estimation. A simple one-dimensional numerical inversion allows the estimation of the distance function via the parameters of the implied Marshallian inverse demand functions. This paper develops the formal theory for using distance functions in this context, and reports on initial trials on the operational feasibility of the method.

Nurse practitioner standards : an Australian and New Zealand research collaboration

This paper will report the findings from research conducted in Australia and New Zealand to inform development of standards for nurse practitioner education and practice competencies. In New Zealand and Australia the nurse practitioner is a new and unique level of health-care provider. The shifting boundaries caused by health-care reform have created impetus and demand for development of new models of health-care, but have also created some uncertainty regarding nurse practitioner standards, education and models of care. The title, Nurse Practitioner, is now legislated in New Zealand and most jurisdictions in Australia but there is scant research to inform development of nurse practitioner standards. This research, sponsored by the Australian Nursing Council and the Nursing Council of New Zealand, was conducted to develop generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. The study involved collection and triangulation of data from a range of sources across Australia and New Zealand including: in-depth interviews with 15 nurse practitioners from different geographical and clinical contexts; curriculum survey of all nurse practitioner courses in the two countries and interview with convenors of these courses; collation of the authorisation/registration processes and policies from states and territories in Australia, New Zealand and internationally. These data were analysed within and across the data modalities to provide information on standards for nurse practitioner practice and education. Findings from the study included identification of the core role of the nurse practitioner as it is expressed in New Zealand and Australia and generic standards for nurse practitioner competencies, education and authorisation. These findings will standardise expectations, support mutual recognition of nurse practitioner authorisation across the two countries and make an important contribution to the current international debate on nurse practitioner standards and scope of practice.