Practitioner perspectives on the family risk evaluation tool : an aide to decision making or 'just another form to fill in'?

The findings of research that explored how child protection practitioners in Queensland used the Structured Decision Making (SDM) tools are presented, focusing on how the Family Risk Evaluation tool (FRET) was used in decision making. The main finding was that the FRET was not used to assist the decision making of practitioners and consequently was ineffective in targeting the children most in need of a service. For practitioners, it was 'just another form to fill in'. As suggested by the participants in this research, a better strategy than the implementation of the SDM tools to improve decision making is the development of practitioner expertise through higher education.

Bacille Calmette-Guérin vaccine-related disease in HIV-infected children: a systematic review

Objective: To describe the characteristics and risk of bacille Calmette-Guérin (BCG) vaccine related disease in human immunodeficiency virus (HIV) infected infants.
Methods: Systematic literature review of articles published from 1950 to April 2009 in the English language. We identified all microbiologically confirmed cases of disseminated BCG disease in vertically HIV-infected children reported in the literature.
Results: Sixteen observational studies and 11 case reports/series were included. Observational studies suffered from high rates of loss to follow-up and death. Loco-regional BCG disease was reported in both HIV-infected and non-infected children. Disseminated BCG disease was reported only in children with immunodeficiency and only in studies employing sophisticated laboratory techniques. Sixty-nine cases of disseminated BCG were identified in the literature: 47 cases were reported in six observational studies, the majority (41/47) from the Western Cape of South Africa. A Brazilian cohort study reported no cases of disseminated BCG amongst 66 HIV-infected children observed over a 7-year period. A recent South African surveillance study reported 32 cases of disseminated BCG over a 3-year period, estimating the risk of disseminated BCG to be 992 per 100 000 vaccinations in HIV-infected children. Few cases of severe disseminated TB were reported in the cohort studies among HIV-infected children vaccinated with BCG.
Conclusion: Data on the risk of BCG vaccination in HIV-infected children are limited. Targeted surveillance for BCG complications employing sophisticated diagnostic techniques is required to inform vaccination policy.

How active are rural children in Australian physical education

Physical education lessons offer a venue for children to accrue valuable and health-conferring time being physically active. The first Australian direct observational data are presented on activity of year 3 and 4 children during physical education. Analysis accounts for the nested nature of the data through multi level logistic regression using 13,080 records within 231 lessons within 18 randomly selected schools. Activity was analysed in relation to lesson context (focus of lesson), child gender, school year of child, teacher gender, lesson duration and start time. Children spent 36.7% of a lesson in moderate to vigorous and 12.9% in vigorous activity. Most of the lesson was spent in the context of management/instruction (37.4%), followed by games (25.0%), skill (21.4%), and fitness (14.7%). The highest level of moderate to vigorous activity was observed in the fitness lesson context (61.9%), followed by skill (46.4%), games (42.6%) and management/instruction (17.1%). Moderate to vigorous activity was significantly higher for boys than girls. There was no significant difference in moderate to vigorous activity in lessons led by male or female teachers. However vigorous activity was significantly higher for female led lessons. Children participated in less physical activity during physical education lessons timetabled in the afternoon, compared to physical education lessons time-tabled in the morning. Physical activity levels were not related to lesson duration. Physical education lessons can potentially be more active. However improvement rests on school capacity and may require a health promoting schools approach to implement curricular policy.

Getting the complete picture : combining parental and child data to identify the barriers to social inclusion for children living in low socio-economic areas

Background: Childhood mental health problems are prevalent in Australian children (14–20%). Social exclusion is a risk factor for mental health problems, whereas being socially included can have protective effects. This study aims to identify the barriers to social inclusion for children aged 9–12 years living in low socio-economic status (SES) areas, using both child-report and parent-report interviews.

Methods: Australian-born English-speaking parents and children aged 9–12 years were sampled from a low SES area to participate in semi-structured interviews. Parents and children were asked questions around three prominent themes of social exclusion; exclusion from school, social activities and social networks.

Results: Many children experienced social exclusion at school, from social activities or within social networks. Overall, nine key barriers to social inclusion were identified through parent and child interviews, such as inability to attend school camps and participate in school activities, bullying and being left out, time and transport constraints, financial constraints and safety and traffic concerns. Parents and children often identified different barriers.

Discussion: There are several barriers to social inclusion for children living in low SES communities, many of which can be used to facilitate mental health promotion programmes. Given that parents and children may report different barriers, it is important to seek both perspectives.

Conclusion: This study strengthens the evidence base for the investments and action required to bring about the conditions for social inclusion for children living in low SES communities.

Obesity prevention in children and adolescents

Childhood and adolescent obesity has been increasing in most middle- and high-income countries, and, as with adult obesity, this has been driven by increasingly obesogenic environments, especially the food environment. This constitutes a “market failure,” signaling the need for government interventions with policies, programs, and social marketing. Population prevention strategies are critical, and children and adolescents should be the priority populations. Food marketing to children is a central policy issue for governments to address, and comprehensive regulations are needed to provide substantive protection for children. Community-based intervention programs show some real promise in reducing childhood obesity, but the 2 big challenges ahead are to ensure that there is substantial ongoing funding so that the community capacity to promote healthy weights can be scaled up to a national level and to ensure that policies are in place to support these efforts. The social and cultural shifts that support healthy eating and physical activity occur differentially, and special efforts are needed to reduce the socioeconomic gradients associated with childhood obesity. A positive public health approach encompassing environmental, regulatory, sociocultural, and educational strategies offer the best chance of reducing obesity without increasing disordered eating patterns.

Family in transition: parents, children and grandparents in lesbian families give meaning to 'doing family'

Lesbian parents, their children and grandparents ‘do family’ in rich and diverse ways. This article draws on innovative grounded theory research using qualitative, multi-generational family interviews with twenty lesbian- parented families living in Victoria, Australia. The intersection between the public and the private in lesbian family life has been seriously neglected by family researchers, and in particular the perspectives of family members other than the lesbian parents themselves. This article addresses the question of ‘How members of lesbian-parented families define and describe their family’, and the results reported here focus on children’s and grandparents’ views, because they are the voices less well represented in the literature. Children and grandparents straddle both mainstream and marginalized spaces as they negotiate contemporary family life. We examine the interface and tensions between the traditional and the transformative, and the implications of these findings for family therapists are briefly discussed.

Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

Treaties as tools of foreign policy : a psychopolitical inquiry via Keatings's vision for Australia

Paul Keating will be remembered by some Australians as a visionary. As Prime Minister he outlined the structure of external and domestic reform that he believed would guarantee global security for all Australians. Driving these reforms, more often than not, were interstate agreements, often in the form of multilateral treaties, sometimes in the guise of bilateral compromise, rarely as unilateral declarations. In areas as diverse as collaborative scientific research or the protection of children in the workplace, the Keating Executive set out, through codification, to transform Australia’s political landscape. The fields of trade, military, environmental and human rights were all included in the attempts by Keating to forge a new image of and for Australia in the Asia Pacific region. Treaties were vital agents of change in this milieu in the bid to reformulate regional perceptions of Australia. The path of inquiry in this thesis stemmed from a quest to examine the origin, role, purpose and efficacy of treaties in the Keating Government’s foreign policy aimed at regional military security. In order to make this examination it develops a polyphonic1 analytical model whose purpose is to explore the psychopolitical underpinnings of these agreements. Thus the thesis has a two fold task. To develop an analytical model of how treaties work as tools of foreign policy and to outline and assess the Keating treaty strategy. Its principal contribution is on the theoretical side.

Practising gender : the production of identity by school children

The thesis utilises ‘practice theory’ to argue that the self is not only an effect of social practices but also a technique for action and develops an alternative way of explicating and conceptualising the constitution of the self within the micro-practices of routine, everyday life. This is in contrast to a general tendency within ‘practice theory’, ‘constructionist’ and ‘discursive’ approaches towards a determinist conception of the self. The thesis explores this conceptual framework in fieldwork focussed on formation and production of gender-identity among young school children and offers a new perspective of gender-identity in the classroom. The thesis provides a fourfold contribution: (1) It provides insights into how in the classroom, children take up (conventional) gender differentiated conduct and dispositions in order to forge both their identity and the establishment of a social order based on gender. This gender order is not simply imposed on them by teachers but is actively constructed by the children. The thesis provides insights into how the children in the classroom seize and appropriate the practices of gender for their own ends. These ends, I argue, are the construction of their gender-identity, and the establishment and maintenance of a ‘matrix of intelligibility’. (2) It offers a close-up illustration of how gender construction is negotiated and contested between girls and boys. This is characterised as largely a struggle for enablement — the power to be and to do — rather than as a struggle of one gender over another. (3) It develops an analysis of classrooms as productive sites, as ‘complex strategical situations’ in which the participating agents — the teachers and students—deploy and utilise available resources in their ongoing construction of the world. This suggests that that the social world is not as unitary and totalising as ‘constraint perspectives’ within practice theory often imply. (4) It proposes methodological perspectives and strategies for researching empirically the day-to-day production of gender and for capturing that complex and often elusive process ‘in flight’. It shows the value of an ‘ascending analysis’, one that does not foreclose findings on the basis of a pre-existing theoretical position, and the rich potential of ‘flashpoints’ as a way of illuminating ongoing and often ‘unremarkable’ and therefore unnoticed practices of gender production. The theoretical terrain explored a range of theorists on the self not usually brought together, including Butler, Rose, Foucault, Giddens and Garfinkel and Schatzki. These theorists share in common the perspective that social practices rather than the agent or social totality are the ontological basis of the social world. It is argued that the self is constituted in its enactment and the thesis pursues Foucault’s (2002) question of how the self participates in its own subjectification. The empirical focus of the thesis examined the activities of children at school for insights into how they participated in the making of their gender-identity. The research addressed the questions: (1) To what extent do children construct their gender-identity and what kinds of encouragement do they receive for this? (2) To what extent did the children seem to be appropriating gender practices and inciting the making of gender-identity in the classroom? (3) To what extent can the classroom be viewed as a site of gender contestation and borderwork? Using the concept of ‘flashpoints’, — significant or poignant moments in the classroom — classroom activities were observed to catch gender-identity production ‘in flight’ and to describe how the children seize upon moments to make gender salient. Year Three children in five classrooms in two Victorian schools were observed during English communication and literacy lessons. Individual interviews with teachers in the participating schools and group interviews with the children from the classrooms were undertaken to amplify the observations. Much of the children’s behaviour can be interpreted as their efforts to make gender salient in social interactions. Gender-identity production and gender ‘border work’ (Thorne, 1993) and contestation appeared to be a major activity and preoccupation of the children, even in the face of teacher’s attempts to encourage a gender-neutral environment The children were often more active than the teachers in imposing the ‘gender agenda’ identified by Evans (1988). Overall, this thesis contributes to the development of the theory of subjectivity and identity formation. Social practices are not imposed and individuals seize upon social practices to further their own ends. It is through these routine, everyday activities that social practices are reproduced. The study provides an avenue for understanding the actions of children and the operation of gender power and border work within the classroom.

Calculators, mathematics and young children : a study of six children using calculators as part of the mathematics curriculum during their first two years of school

The thesis investigates the role a calculator can play in the developing number knowledge of three girls and three boys as part of their mathematics program, during their first two years at primary school. Random sampling was used initially to select six girls and six boys from the twenty-four children entering a 1993 prep class. These twelve children were interviewed on entrance to school and based on the performance of the twelve children on the initial interview, a girl and a boy were chosen from the higher, middle and lower achievers to take part in the full study. The class teachers involved were previously participants in the ‘Calculators in Primary Mathematics’ research program and were committed to the use of calculators in their mathematics program. A case study approach using qualitative methods within the activity theory framework is used to collect relevant data and information, an analysis of five interviews with each child and observations of the children in forty-one classroom lessons provides comprehensive data on the children's developing number knowledge during the two years. The analysis questionnaires establishes each teacher's perceptions of the children's number learning at the beginning and end of each year, compares teacher expectations with children's actual performance for the year and compares curriculum expectations with children's actual performance. A teacher interview established reasons for changes in teaching style; teacher expectations; children's number learning; and was used to confirm my research findings. An activity theory framework provides an appropriate means of co-coordinating perspectives within this research to enable a description of the child's number learning within a social environment. This framework allows for highlighting the mediation offered by the calculator supporting the children's number learning in the classroom. Levels of children's developing number knowledge reached when working with a calculator and as a result of calculator use are mapped against the levels recommended in ‘Mathematics in the National Curriculum’ (National Curriculum Council, December 1988), and the Curriculum and Standards Framework: Mathematics (Board of Studies 2000). Findings from this comparison illustrate that the six children's performance in number was enhanced when using a calculator and indicate that on-going development and understanding of number concepts occurred at levels of performance at least two years in advance of curriculum recommendations for the first two years of school.

Policy framework for a knowledge society : families and knowledge

My thesis examines the link between families, harm and knowledge in a society where knowledge is increasingly the central organising principle (Bohme 1997: 449-450; Stehr 1994: 6), and represents the capacity for action (Stehr 1994: 8). I observed as a consultant in the 1990s that practitioners in family work were able to articulate what works but often unable to articulate why and therefore unable easily to replicate what works. This time coincided with increasing commentary on complexities of living, capacity of families to cope, identification of the scale of family harm, and use of the term 'the knowledge society'. My aim is to identify why what works, works with families exhibiting harmful behaviours and families acquiring knowledge from learning everyday life skills so as to lead less harmful and more fulfilling lives. And by such explanations inform, replicate and scale up practice to benefit more families exhibiting harm. I conceptualise the outcome as a sequence of family, community and policy work in an ecological framework (Bronfenbrenner 1979) within a knowledge society. My method was a year-long action research project with a family support service in New South Wales. I engaged in reflective practice with workers, and a parallel literature review that supported additional reflective practice. I found growing complexity of life requires growing knowledge. I found a distinction between everyday and abstract life worlds, and with families principally acting in the everyday life world. It is a world from which some families and their members seek to escape, often by means of harmful behaviours of neglect, abuse and violence. I substantiated the link that the family support service of my study sees between relationships, behaviours and affects; and I linked this in turn with its therapeutic engagement of the whole family — adults and children, male and female, victims and perpetrators. This engagement involves a process of learning (Rogers 1967: 280) to acquire fulfilling behaviours. It is a process of adult and experiential learning of relationship skills, drawing on under-used reserves of families. Relationship skills form a basis of acquiring other life skills since most require relationships with others to perform life skills. Combining the sequence of family, community and policy work with workers engaging in reflective practice of their work creates capacity for community institutions to replicate and scale up what works and why. Understanding this sequence may assist community institutions to inform policymakers of benefits common to all policy interests of such replication and scaling up. I conceptualise a policy framework of families and knowledge in a knowledge society and two lower level frameworks of process and content of life skills. Implications of these for practice, policy, and theory include a greater distinction between everyday and abstract knowledge and skills; recognition of a sequential process of information, learning, and knowledge; and inclusiveness and fluidity in learning in diverse adult learning settings and in family support professions.

Multi-type maltreatment : relationships between familial characteristics, maltreatment and adjustment of children and adults

This thesis examines the nature, extent and impact of multiple forms of maltreatment (multi-type maltreatment) from within a developmental victimological framework. The interrelationships between sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence are assessed. The role of family variables in predicting maltreatment and the relative contribution of child maltreatment and family variables to adjustment are evaluated. Risk factors for multi-type maltreatment, and the relationship between multi-type maltreatment and adjustment are explored. The major theories of child development are reviewed. As well as exploring the relevance of developmental theories to understanding the impact of child maltreatment, factors influencing the emergence of child psychopathology are reviewed from a developmental psychopathology perspective. Ecological and developmental perspectives on how child maltreatment translates into the behavioural and emotional adjustment problems of children are integrated in the Child Maltreatment: Risk and Protection Model. After exploring some of the relevant conceptual issues, the literature on the prevalence and impact of each maltreatment type is reviewed, and the literature on multi-type maltreatment critiqued. Methodological and ethical concerns with the conduct of research in the field of child maltreatment using direct assessment of children led to the need for an instrument to assess parent perceptions of each of the types of abuse and neglect, as well as adult retrospective reports. Data are presented from two cross-sectional questionnaire-based studies using the Parent and Adult versions of the Family and Life Experiences Questionnaire which was designed to assess perceptions of children's experiences of sexual abuse, physical abuse, psychological maltreatment, neglect and witnessing family violence. Problems with the isolated focus of research on single forms of child maltreatment are addressed by the inclusion of each of these forms of child maltreatment within a single research design. Respondents for both studies were volunteers recruited from counselling agencies, medical, community health, child care and fitness centres and a first year psychology course. Parents (N=50) described their perceptions of primary school children's family characteristics, experiences of maltreatment and adjustment. Children's behavioural adjustment (internalising and externalising), sexual behaviours, emotions, self-esteem, gender identity, family adaptability and cohesion, parental traditionality, parental sexual punitiveness, interparental relationship satisfaction, and demographic characteristics are assessed in the study of Parents' perceptions. A large degree of overlap between the different types of abuse and neglect was found, with a high proportion of parents describing children's experiences of multiple forms of child maltreatment. Using both maltreatment and family characteristics to predict internalising behaviour problems, neglect and family cohesion were the only unique predictors. Family adaptability and cohesion were the only unique predictors of externalising behaviour problems. Physical and sexual abuse were not predicted from family characteristics; neglect was predicted, but no variables provided unique prediction. Unique predictors of psychological maltreatment were family cohesion, parental sexual punitiveness and divorce. Divorce was the only variable with significant unique prediction of the child witnessing family violence. Family background and family functioning were found to predict some forms of maltreatment, but to also be important factors mediating the adjustment of children, independent of maltreatment. The results are interpreted within an ecological framework, integrating risk factors for maltreatment with experiences of abuse and neglect and subsequent adjustment in childhood. Retrospective reports of adults' (N=175) own childhood family characteristics, experiences of maltreatment, and reports of their current adjustment are also studied. Included with the adult version of the FLEQ were the Trauma Symptom Checklist-40, Rosenberg's Self-esteem Scale, and the Family and Adaptability and Cohesion Evaluation Scale-II. Similar results were found in the in the Adult Study. As hypothesised, adult retrospective reports of the five different types of child maltreatment were found to be highly intercorrelated. Family characteristics predicted maltreatment and adjustment scores and discriminated between single and multi-type maltreatment. Maltreatment scores also predicted adult adjustment. As the number of maltreatment types increased, there was an increase in the number of adjustment problems reported. Alternate hypotheses regarding the possible operation of mediating and moderating processes in the relationships between family characteristics, maltreatment and the adjustment of adults were assessed. Finally, the results of these investigations are discussed and interpreted in the light of extant findings previously reviewed. Data from the two major empirical studies are used to demonstrate the overlap between different child maltreatment categories, and the extent and impact of multi-type maltreatment. The results show that children are vulnerable to more than one type of maltreatment. Individuals who experience a number of different forms of maltreatment had greater adjustment problems than those experiencing only one or two different types of abuse or neglect. Dysfunctional families place children at risk of child maltreatment. Negative family characteristics lead to adjustment problems in children and adults. The type of maltreatment having the most damaging effect on children was neglect, and in the long-term, sexual abuse. A multi-dimensional approach to prevention and intervention needs to be adopted, based on the co-morbidity of maltreatment types, and the likelihood of children experiencing further abuse or neglect of a different type. Dysfunctional family dynamics which place children at risk of multi-type maltreatment, and mediate the effects of maltreatment on adjustment, need to be specifically targeted with support and family intervention strategies. Risk-assessment measures used by Child Protection workers must include adequate knowledge of the inter-relationships between maltreatment types, and the particularly negative impact on adjustment of experiencing many forms of abuse or neglect. Suggestions for future clinical and research work in the area of child maltreatment are developed. The importance of assessing all forms of maltreatment when examining the relationships of maltreatment to adjustment is emphasised. It is recommended that prevention and intervention strategies acknowledge the interrelationships between maltreatment types.

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.

Internationalisation of Singapore television : Singaporean regional and global perspectives and contexts

In this study l investigate the Singaporean characteristics of broadcast media internationalisation. I ask the question "e; Does Internationalisation lead to homogenisation and commercialisation of the television culture in Singapore or does it give way to more diversity, thus stimulating cultural differentiation?"e; . I articulate the constraints and/or tensions of supranational regulation, foreign policy, regional and intraregional alliances upon communication and the cultural and social effects as they impact on and respond to production, programming, scheduling and output in Singapore. I explain how Singaporean Television media culture takes part in the processes of globalisation, and how it challenges existing cultures and creates new and alternative symbolic and cultural communities, within the context of regional communication. In this thesis 1 conclude that whilst Singapore definitely does not have equity in information, wealth or resource flows it is attempting to liberalise. To do so, the government recognises that serious inadequacies and imbalances must be addressed and that the path to greater political and economic growth is through an actively informed public. Despite regulatory restrictions on data flow and technical and service ownership, Singapore is encouraging regional alliances, depoliticising cultural differences and concentrating on economic imperatives to build mutual knowledge and understanding, multilateral agreements, collective ownership, mutual exchange and cooperative dissemination.

Chronic disease self-management programs : perspectives on enablers and barriers to GP and patient engagement

Aims & rationale/Objectives : Chronic disease self-management programs (CDSMP) are increasingly being integrated into the health system to improve the care of people with chronic conditions. Despite activity at both policy and program levels, GPs as the 'gatekeepers' to the health system have generally not been well informed or engaged in this process. This study, in collaboration with 3 Victorian Divisions of General Practice, sought both GP and patient perspectives on enablers and barriers to engagement in self-management programs.
Methods : Interviews were conducted with GPs (n=20) and consumers (n=45) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.
Principal findings : Lack of education/information and uncertainty about the effectiveness of self-management programs were key barriers for both GP and patient engagement. Programs that were sustainable and utilised existing community resources were viewed as enablers to increase uptake. GP and patient preferences for disease specific or generic CDSMP differed.
Discussion : Outcomes from the recent Council of Australian Governments' meeting suggest that self-management will be a centerpiece in forthcoming chronic disease initiatives. International evidence has highlighted the need for GP and patient engagement as critical in ensuring the recruitment of a critical mass of individuals to participate in CDSMP to ensure the sustainability of such initiatives. Insight from this study indicates that GPs and patients are not well informed about self-management, have different preferences to current policy trends and identifies several other barriers which need to be addressed if CDSMP are to be successful.
Implications : Identification of barriers and enablers of GP and patient engagement in self-management is essential in shaping current policy initiatives and delivery of future programs. This is supported by international evidence which indicates strongly that GP engagement in particular is crucial to the success of these programs.
Presentation type : Paper