End-of-life care for aged care residents presenting to emergency departments

Background: The number of patients from Aged Care presenting to acute care is increasing, many of whom have a life limiting illness.

Aims: To identify differences in relation to Aged Care Residents presenting to Emergency departments who died during a hospital admission compared to those who were referred to the hospital based palliative care.

Methods: Review of a stratified random sample of 90 Aged Care residents transferred to acute care who died during admission in 2009; half the sample received palliative care. Comparisons were made with regard to age; gender; co-morbidities; symptoms, investigations and active treatment; prior admissions and costs.

Results: The median age of patients was 87.5 years, 61% were female and 38% had three or more admissions in the year prior to death. Patients with a length of stay of four or more days were 2.98 times (CI, 95%:1.11-8.03) and patients with agitation were 3.08 (CI 95%:1.10- 8.64) times more likely to be referred to palliative care. Patients who received palliative care had significantly fewer investigations or active treatment in the 24 hours prior to their death (p< 0.01) and palliated patients had significantly lower average costs per day of admission ($1022, SD=$441) compared to those who were not palliated ($ 831; SD= $ 1041) (p< 0.001).

Discussion: Our study indicates there is a difference between dying patients who received palliative care compared to those who did not in an acute care setting. Further research into the outcomes of patients discharged back to Aged Care facilities for palliative care warrants investigation.

Social media in disaster response : Queensland Police Service - public engagement during the 2011 floods

Social Media, particularly Microblogging services, are now being adopted as an additional tool for emergency service agencies to be able to interact with the community at all stages of a disaster. Unfortunately, no standard framework for Social Media adoption for disaster management exists and emergency service agencies are adopting Social Media in an ad-hoc fashion. This paper seeks to provide a general understanding of how Social Media is being used by emergency service agencies during disasters, to better understand how we might develop a standardised framework of adoption. In this study of the 2010/11 Queensland Flood event, Facebook broadcast messages from the Queensland Police Service to the general public, were analysed by genre. Findings show that these Microblogging activities were mostly about information distribution and warning broadcasts and that the strength of Social Media for two-way communication and collaboration with the general public, was under-utilised during this event.

Governance disclosure on the internet : the case of Australian State Government Departments

This paper examines corporate governance disclosures on the websites of Australian state government departments. The study focuses on the nature and extent of governance information and the ease of finding this information directly on department websites and also in annual reports which are downloadable from websites. Our sample comprises six departments from each of the six states in Australia, giving a sample size of 36 departments. Our findings indicate considerable variability in both the level of disclosure and the accessibility of the information disclosed. The study also highlights a lack of consensus regarding the meaning of governance and what governance comprises, together with the need for a more structured approach to communicating governance information to stakeholders.

Victims' perceptions of a new model of sexual assault investigation adopted by Victoria Police

This paper evaluates a method of operation for sexual assault investigation recently developed by Victoria Police (Australia). The model (which is new to Victoria) is characterised by two core components: the establishment of specialist teams of investigators (responsible for investigation and victim support) and service sites referred to as ‘Multidisciplinary Centres’ where all key services are provided to victims in a single location separate from police stations. The approach consisted of in-depth interviews with 25 victims of sexual assault aged between 15 and 54 years. The overriding theme to arise from the interviews was the importance to victims of being treated with dignity and respect; six elements were highlighted by victims as assisting this. These elements are presented along with evidence to demonstrate that the police response to victims has become more victim-centred under the new model of service delivery.

Pandemic (H1N1) Influenza 2009 and Australian emergency departments : implications for policy, practice and pandemic preparedness

Objective: To describe the reported impact of Pandemic (H1N1) 2009 on EDs, so as to inform future pandemic policy, planning and response management.

Methods: This study comprised an issue and theme analysis of publicly accessible literature, data from jurisdictional health departments, and data obtained from two electronic surveys of ED directors and ED staff. The issues identified formed the basis of policy analysis and evaluation.

Results: Pandemic (H1N1) 2009 had a significant impact on EDs with presentation for patients with ‘influenza-like illness’ up to three times that of the same time in previous years. Staff reported a range of issues, including poor awareness of pandemic plans, patient and family aggression, chaotic information flow to themselves and the public, heightened stress related to increased workloads and lower levels of staffing due to illness, family care duties and redeployment of staff to flu clinics. Staff identified considerable discomfort associated with prolonged times wearing personal protective equipment. Staff believed that the care of non-flu patients was compromised during the pandemic as a result of overwork, distraction from core business and the difficulties associated with accommodating infectious patients in an environment that was not conducive.

Conclusions: This paper describes the breadth of the impact of pandemics on ED operations. It identifies a need to address a range of industrial, management and procedural issues. In particular, there is a need for a single authoritative source of information, the re-engineering of EDs to accommodate infectious patients and organizational changes to enable rapid deployment of alternative sources of care.

Moving right along: what powers do police have to 'move-on' protestors?

When police removed a young woman’s “tent dress” this week at the Occupy Melbourne encampment, it was yet another controversial interaction between protesters and authorities.

Evaluating police interviewing practices with suspects in child-sexual abuse cases

This article examined adherence to current best practice recommendations for police interviewing of individuals suspected of committing child-sexual offences. We analysed 81 police records of interviews (electronically recorded and then transcribed) with suspects in child-sexual abuse cases in England and Australia. Overall we found areas of skilled practice, indicating that police interviewing in Australia and England is in a far better place than 20 years ago. However, this study also demonstrated that there is still a gap between the recommended guidelines for interviewing and what actually happens in practice. Specifically, limitations were found in the following areas: transparency of the interview process; introduction of allegations; disclosure of evidence; questioning techniques; and the interviewing approach or manner adopted. The practical implications of these findings are discussed.

An examination of police officers' beliefs about how children report abuse

The aim of this study was to examine police officers’ beliefs about how children report abuse. Fifty-two officers read transcripts of nine interviews, which were conducted with actual children or adults playing the role of the child witness. Officers indicated whether they thought the interviews were with an actual child and justified their decisions. In-depth interviews were conducted to determine the reasons behind their decisions. Overall, officers’ decisions were no better than chance. When making these decisions, officers focused on three areas: whether they considered the child's language to be age-appropriate, whether they thought that the content of the statement was plausible, and whether they thought that the child had acted in a manner consistent with recollecting a traumatic event. The findings suggest that the characteristics officers rely on when evaluating children's statements of abuse are not reliable indicators. They suggest that officers’ beliefs about these statements need to be challenged during training to reduce the effects of those beliefs on their later decisions.

Improving police officers' perceptions of sexual offending through intensive training

We examined whether specialist police training on the dynamics of sexual offending can modify officers’ victim-blaming attitudes and negative perceptions regarding likely case authorization. The sample included 77 Australian police officers specialising in sexual assault investigation. The training, delivered face to face over 4 weeks, included focus on identifying elements of grooming in offending relationships and how these elements can be elicited from victims and suspects within a narrative interviewing framework. Officers’ perceptions of cases were assessed immediately pre- and posttraining using a series of case scenarios. For each scenario, officers rated (on a 10-point Likert-type scale) their confidence that the case should be authorised to proceed to prosecution and the responsibility attributable to the victim. For each case, officers also listed up to 5 factors to justify their case authorization decision. Overall, confidence in case authorization increased from pre- to posttraining, whilst perception of victim “responsibility” decreased. The pattern of results, including the qualitative evidence to justify officers’ decisions, support that the attitude change was due to greater understanding of the dynamics of sexual offending. The implications for police trainers, and directions for future research, are discussed.

Australian police officers' perceptions of sex offender registries

Sex offender registration schemes exist in most English speaking countries to assist police in the investigation of new crimes and to deter known offenders. To date, however, very little research has examined the efficacy of these registers. This study addresses this issue by providing the first qualitative analysis of police officers' perceptions of registration schemes. Twenty-four Australian police professionals (whose jobs were primarily associated with the operation of sex offender registration schemes) participated in focus groups in groups of 2–5 officers. Officers were recruited across three jurisdictions where quite distinct registration schemes operated. They were asked to reflect on how their register operates, how effective and efficient it is, the challenges faced in its administration and how the registry process might be improved. The key challenges addressed included; limitations in risk assessment expertise, restriction in legislative powers, and inadequate opportunity for specialisation. The implications for current practice are discussed.