Professional attitudes to sex offenders: implications for multiagency and collaborative working

Recent years have seen the development and implementation of a range of multi-disciplinary and partnership approaches to managing risk in known sex offenders, involving collaboration between justice and human services agencies. Potential barriers to the development of effective multidisciplinary practices arise when participating professionals hold different attitudes about those they are responsible for managing. This paper examines differences in attitudes towards sex offenders in two professional groups – police officers and allied health workers. The results suggest that police officers tend to hold more negative views than those who deliver treatment and support services. They are more likely to believe that offenders cannot change their behaviour and should be subject to more punitive sanctions. These findings are discussed in relation to judgements of both risk and dangerousness and associated decisions about the appropriate management of sex offenders in multi-agency and multi-disciplinary working forums.

Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial

BACKGROUND: Our previous work showed that providing additional rehabilitation on a Saturday was cost effective in the short term from the perspective of the health service provider. This study aimed to evaluate if providing additional rehabilitation on a Saturday was cost effective at 12 months, from a health system perspective inclusive of private costs. METHODS: Cost effectiveness analyses alongside a single-blinded randomized controlled trial with 12 months follow up inclusive of informal care. Participants were adults admitted to two publicly funded inpatient rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus additional Saturday rehabilitation. Incremental cost effectiveness ratios were reported as cost per quality adjusted life year (QALY) gained and for a minimal clinical important difference (MCID) in functional independence. RESULTS: A total of 996 patients [mean age 74 years (SD 13)] were randomly assigned to the intervention (n = 496) or control group (n = 500). The intervention was associated with improvements in QALY and MCID in function, as well as a non-significant reduction in cost from admission to 12 months (mean difference (MD) AUD$6,325; 95% CI -4,081 to 16,730; t test p = 0.23 and MWU p = 0.06), and a significant reduction in cost from admission to 6 months (MD AUD$6,445; 95% CI 3,368 to 9,522; t test p = 0.04 and MWU p = 0.01). There is a high degree of certainty that providing additional rehabilitation services on Saturday is cost effective. Sensitivity analyses varying the cost of informal carers and self-reported health service utilization, favored the intervention. CONCLUSIONS: From a health system perspective inclusive of private costs the provision of additional Saturday rehabilitation for inpatients is likely to have sustained cost savings per QALY gained and for a MCID in functional independence, for the inpatient stay and 12 months following discharge, without a cost shift into the community. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry November 2009 ACTRN12609000973213 .

Sleep disturbances and associated health outcomes: an epidemiological study

 This series of 8 peer-reviewed published studies provided novel evidence demonstrating a strong, independent association between daytime sleepiness, disturbed nocturnal sleep and pathological sleep disorders (sleep apnoea and insomnia) and deleterious health outcomes across several critical age-related developmental periods among three representative, population-based samples from Australia, Norway and the USA.

The work-based predictors of job engagement and job satisfaction experienced by community health professionals

Background: Job engagement represents a critical resource for community-based health care agencies to achieve high levels of effectiveness. However, studies examining the organisational sources of job engagement among health care professionals have generally overlooked those workers based in community settings.
Purpose: This study drew on the demand-control model, in addition to stressors that are more specific to community health services (e.g., unrewarding management practices), to identify conditions that are closely associated with the engagement experienced by a community health workforce. Job satisfaction was also included as a way of assessing how the predictors of job engagement differ from those associated with other job attitudes.
Methodology/Approach: Health and allied health care professionals (n = 516) from two
Australian community health services took part in the current investigation. Responses from the two organisations were pooled and analysed using linear multiple regression.
Findings: The analyses revealed that three working conditions were predictive of both job engagement and job satisfaction (i.e., job control, quantitative demands and unrewarding management practices). There was some evidence of differential effects with cognitive demands being associated with job engagement, but not job satisfaction.
Practice Implications: The results provide important insights into the working conditions that, if addressed, could play key roles in building a more engaged and satisfied community health workforce. Further, working conditions like job control and management practices are amenable to change and thus represent important areas where community health services could enhance the energetic and motivational resources of their employees.

Disability studies: educating for inclusion

Education systems worldwide will only successfully serve the needs of people with disability when we inclusively examine and address disabling issues that currently exist at school level education as well as further and higher education and beyond. The chapters contributing to this edited volume are presented to assist readers with a critical examination of contemporary practice and offer a concerted response to improving inclusive education. The chapters address a range of important topics related to the field of critical disability studies in education and include sections dedicated to Schools, Higher Education, Family and Community and Theorising. The contributors entered into discussions during the 2014 AERA Special Interest Group annual meeting hosted by Victoria University in Australia. The perspectives offered here include academic, practitioner, student and parent with contributions from Australia, New Zealand, Nigeria, the UK and the US, providing transnational interest. This book will appeal to readers who are interested in innovative theoretical approaches, practical applications and personal narratives. The book is accessible for scholars and students in disciplines including education, sociology, psychology, social work, youth studies, as well as public and allied health. The Introduction by Professor Roger Slee (The Victoria Institute, Victoria University, Australia) and Afterword by Professor David Connor (City University of New York) provide insightful and important commentary. Cover photograph by Paul Dunn and design by Hendrik Jacobs.

Explaining the variation in the management of lifestyle risk factors in primary health care: a multilevel cross sectional study

Background

Despite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice. Little is known about the relative importance of various determinants of practice.

This study aimed to examine the relative importance of provider characteristics and attitudes, patient characteristics and consultation factors in determining the rate of assessment and intervention for lifestyle risk factors in PHC.

Methods

A prospective audit of assessment and intervention for lifestyle risk factors was undertaken by PHC nurses and allied health providers (n = 57) for all patients seen (n = 732) over a two week period. Providers completed a survey to assess key attitudes related to addressing lifestyle issues. Multi-level logistic regression analysis of patient audit records was undertaken. Associations between variables from both data sources were examined, together with the variance explained by patient and consultation (level 1) and provider (level 2) factors.

Results

There was significant variance between providers in the assessment and intervention for lifestyle risk factors. The consultation type and reason for the visit were the most important in explaining the variation in assessment practices, however these factors along with patient and provider variables accounted for less than 20% of the variance. In contrast, multi-level models showed that provider factors were most important in explaining the variance in intervention practices, in particular, the location of the team in which providers worked (urban or rural) and provider perceptions of their effectiveness and accessibility of support services. After controlling for provider variables, patients' socio-economic status, the reason for the visit and providers' perceptions of the 'appropriateness' of addressing risk factors in the consultation were all significantly associated with providing optimal intervention. Together, measured patient consultation and provider variables accounted for most (80%) of the variation in intervention practices between providers.

Conclusion

The findings highlight the importance of provider factors such as beliefs and attitudes, team location and work context in understanding variations in the provision of lifestyle intervention in PHC. Further studies of this type are required to identify variables that improve the proportion of variance explained in assessment practices.

Clinicians’ perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma

Objective: The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma.Methods: A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews.Results: Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients’ requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer.Conclusions: The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making.

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

Background

Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed.

Methods

The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data.

Results

The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices.

Conclusion

The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.

Science, research and social change in Indigenous health – evolving ways of knowing

History tells us of the overwhelming destructive influence of exotic culture, politics and knowledge forms upon the worldview and wellbeing of Indigenous Australians. The power of dominant culture to oppress, control and dominate traditional Indigenous ways of knowing and being has been identified as a being a crucial influence on the health status, future hopes and aspirations of Indigenous Australians. Fundamental to this assertion is that the alienating effect of the belief in and application of the scientific method in relation to learning and knowing is a phenomenon that is incompatible with the law and cultural ways of traditional Indigenous people. The establishment of the Centre of Clinical Research Excellence (CCRE) is predicated upon and responds to a deep need in our community today to synthesise the ideological and epistemological premises of an increasing range of cultures and world views. It recognises that clinical research, for example, is important to the health of Aboriginal and Torres Strait Islander peoples, but also that the way such research is designed and carried out is also crucial to its potential to effect change in and improve the state of Indigenous health in Australia. This paper examines knowledge principles and processes associated with research in Indigenous communities, explores emerging research trends in science and proposes an epistemological framework for synthesis of traditional approaches with those of the scientific paradigm.

Training a system-literate care coordination workforce.

People with chronic complex conditions continue to experience increasing health system fragmentation and poor coordination. To reverse these trends, one solution has been an investment in effective models of care coordination that use a care coordinator workforce. Care coordinators are not a homogenous workforce - but an applied professional role, providing direct and indirect care, and is often undertaken by nurses, allied health professionals, social workers or general practitioners. In Australia, there is no training curriculum nor courses, nor nationally recognised professional quality standards for the care coordinator workforce. With the growing complexity and fragmentation of the health care system, health system literacy - shared understanding of the roles and contributions of the different workforce professions, organisations and systems, among patients and indeed the health workforce is required. Efforts to improve health system literacy among the health workforce are increasing at a policy, practice and research level. However, insufficient evidence exists about what are the health system literacy needs of care coordinators, and what is required for them to be most effective. Key areas to build a health system literate care coordination workforce are presented. Care coordination is more than an optional extra, but one of the only ways we are going to be able to provide equitable health services for people with chronic complex conditions. People with low health literacy require more support with the coordination of their care, therefore we need to build a high performing care coordinator workforce that upholds professional quality standards, and is health literacy responsive.

Menopausal stage and age and perceptions of body image

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

Turning tapes into text: issues surrounding the transcription of interviews

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

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

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

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

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