Child protection and public health: nurses' responsibilities

Background. Health care workers have been recognized as having a key role in the protection and care of Scotland's children, particularly in respect of identification and detection of child abuse. Nurses, especially health visitors, are often the first professionals to suspect that child abuse has taken place. While previous research has found that health visitors have primarily perceived their role as that of providing support and advice to vulnerable families, there are pressures on them to fulfil a more narrow surveillance role. Concurrent with a lack of clarity about the role of health visitors in child protection, there has been increasing recognition that other nurses can also make an important contribution, including those who do not work directly with children.

Aims. The aim of the study was to explore nurses' understanding of their professional responsibilities in relation to child protection, and the potential for nurses to be involved in the protection of children from abuse.

Methods. A qualitative interview-based design was used, and 99 nurses working in an National Health Service trust in a Scottish city were interviewed, either individually or in groups, about their professional involvements in child protection issues. Interview data were subjected to thematic analysis.

Findings. There was lack of consensus among interviewees about the nursing remit in child protection issues, particularly with respect to the extent to which nurses should actively seek to detect cases of child abuse. An emphasis on identification and detection was not easily accepted by many nurses, and was perceived by some to be a change from their more traditional role of supporting families, as well as being potentially in conflict with some public health responsibilities.

Conclusion. In spite of the perception of some nurses that there is a sharp divide between child protection work and public health interventions, many of the child protection roles identified by nurses, such as supporting families, parenting education and service development, are clearly within the ambit of contemporary notions of public health. Furthermore, it is clear that there is a role in child protection for a much wider group of nurses than health visitors.

New money for mental health : will it make things better for rural and remote Australia?

New Australian government funding for the Better Outcomes in Mental Health Care initiative is a significant step forward for mental health, with general practitioners now able to offer direct referrals to psychologists, social workers, occupational therapists and Aboriginal health workers. Incentives for better teamwork between GPs and other mental health professionals have been introduced, but may have unintended consequences, including an exacerbation of workforce shortages in rural and remote areas. Possible solutions to these shortages include rural scholarships for students in the mental health professions; recruitment and retention of students coordinated by university departments of rural health; better access to continuing professional development; and federally funded rural positions and additional financial incentives for rural mental health practitioners.

Action research in health promotion

Objectives This article aims to define what is action research and where it fits in with health promotion practice, through drawing upon associated literature and personal action research experience. It also seeks to investigate the possible reasons why it is that health promotion researchers have not readily taken on the processes of action research strategies.

Rationale The place of action research in health promotion programmes is an important yet relatively unacknowledged and understated activity. It has proven to be very popular with other professional groups, such as in the education, management and social sciences. In terms of health service activity, it is widely established in the fields of nursing and mental health and is beginning to establish itself in medicine. While there are a few health promotion examples to draw upon, they tend to be isolated, dated and often lie outside of the mainstream literature. It is suggested that this continuing state of affairs denies many health promotion researchers a valuable resource for managing effective change in practice.

Conclusion The authors suggest that action research is both a valid and
important research method for health promotion researchers, who are advised to further consider its merits in future studies. This article draws attention to the National Health Service (NHS) South West Regional Office-commissioned Our Healthier Nation: Improving the Competence of the Workforce in Health Promotion participatory action research project, as a means of promoting and validating action research strategy. The authors were all actively involved in this project.

Traffic safety education and health promoting school : a metropolitan and rural pilot study

Traffic Safety Education (TSE) is an important part of a school's program; however, it competes with many other components of schooling such as literacy, numeracy and a number of health areas. Hence TSE provision in Victorian schools has been somewhat fragmented and haphazard in its delivery. This small pilot study involved two metropolitan and two rural schools which attempted to link TSE into mainstream school activities through the new Victorian Essential Learning Standards (VELS) utilising the internationally accepted Health Promoting Schools (HPS) framework.
The findings of the pilot study showed that though schools face many demands, understanding and ownership of TSE is possible when administrative support, professional development and adequate planning time are made available. The report outlines several key recommendations to improve the delivery of Traffic Safety Education in Victorian schools.

Workplace change & the care of the self : health and wellbeing as a professional duty of care?

This paper examines the ways in which transformations in the organisation and practice of teacher’s work have witnessed large numbers of teachers being seen, and seeing themselves, as stressed. These understandings of teacher stress have provoked a number of strategies designed to encourage individuals to take care of themselves – and to take care of themselves in ways that will make schools more effective.

Train without strain : health and amateur athletes

An exercise in historical sociology, this paper investigates the association between training and health made by amateur athletes between about 1860 and WWI. It examines the idea that while exercise benefited a person’s health and well-being, excessive exertion caused potentially life-threatening ‘strain’. The paper sets out the interpretation of contemporary scientific knowledge about the body–which the author terms the ‘physiology of strain’–that underpinned the advice given to those undergoing a training program for amateur competition. The point is made that the imputed effects of exercise on health were deduced from this scientific knowledge; it did not derive from bio-medical investigations specifically addressing these issues. Amateur athletes included people drawn from the professionally educated elite and medical practitioners figured significantly among them. Using insights from Bourdieu and Foucault, it is argued that their social power and professional connections served to legitimate their interpretation of the physiological effects of exercise (denying the value of the training practices of working class professional athletes) and cemented the physiology of strain as a ‘factual’ statement about exercise and health until well into the twentieth century. The data for the paper comes from training manuals, medical journals and other contemporary publications.

Securing the oral tradition : reflective positioning and professional conversations in midwifery education

We postulate that positioning is a powerful tool in guiding and transforming student professional learning and practice development. In our experiences with students enrolled in he Graduate Diploma of Midwifery, we determined that positioning elaborates individual scholarship and identity formation of the learner midwife in practice settings. Positioning Theory, developed by Harré and other authorities, is a psycho-sociological 'ontology' or concept of how individuals metaphorically position or locate themselves, and others, within institutions and societies. Three key components of positioning theory include 'position', 'speech act' and 'storylines', developing from the everyday social interactions of professional conversations. Reflective positioning can be applied as an analytical tool for the moment-to- moment exchanges inherent in practice related conversations, occurring between midwives and midwifery students. These moment-to-moment interactions of professional conversations can be used by students to complete or fill their learning gaps. Positioning therefore, provides a novel, contemporary theoretical framework to 'unpack' or understand the complexity of midwifery practice and yet is complementary with reflective practice. Excerpts are used to demonstrate reflective positioning applications by students. Midwives are encouraged by health services and by the University to provide student support through a 'preceptorship' program to supervise, work with and assess students for competence in midwifery practices. We claim that reflective positioning by students within professional conversations with their preceptor/midwives, are the construction sites for learning and where identity formation of each student as a future midwife is both shaped and transformed. Both academics and managers of health services need to embrace the value of workplace conversations, the sites of rich oral traditions of nursing and midwifery. Thus, in seeking claim to our rich oral traditions, all students will benefit from engagement in reflective positioning to promote their professional learning and practice development.

Development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand

This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand District Health Board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.

'The Other Within' : race/gender disruptions to the professional learning of white educational leaders

Leslie Roman states 'white is a colour too'. Yet the whiteness of educational leaders is rarely questioned, although masculinism—the enduring capacity of different masculinities to remain the norm in leadership—is increasingly under scrutiny. Rarely do white men or women leaders question their whiteness, whereas indigenous and other minority groups, as a consequence of their being 'other than white', are expected to explain their exclusion. Instead, the 'problem' is depicted as the lack of 'the Other', and therefore a problem for and of 'the Other'. This article confronts normative whiteness in educational administration from the perspective of feminist and critical race theory, considering how foregrounding whiteness in leadership is a necessary condition of inclusive education and leadership.

Adapting to rural communities by overseas-born health professionals

Introduction
As with other multicultural nations, cultural diversity is a prominent feature of Australian society that leads to intercultural awareness and respect through citizen interactions. While this enriching multicultural interaction is clearly seen in big cities like Sydney and Melbourne, it can be very different in the Australian rural context. Living in an isolated rural area is challenging for health professionals who were brought up in urban areas, particularly those born overseas as they experience two types of cultural and social adaptation: urban into rural and native culture into new culture.

As a result of workforce shortages, many overseas trained health professionals are recruited to work in Australia, particularly in rural areas. This has given rise to various initiatives and strategies developed to support and assist these health professionals in their dual cultural and social adaptation. These include University Departments of Rural Health and Rural Clinical Schools programs as well as the Rural Workforce Agencies. However, these programs do not extend to those health professionals who were born overseas and trained in Australia as they are ‘Australian graduates’. In this paper we argue that in ways similar to those born and trained overseas, overseas-born Australian-trained health professionals may require additional support during the acculturation process and making the transition to working in rural communities.

Aim
The aim of this study is to examine some aspects of the acculturation of overseas-born Australian trained health professionals working in rural areas. This study seeks to understand the particular issues that emerge as a result of cultural difference in order to propose strategies that may more adequately prepare these Australian graduates for their rural health experience.

Method
Six overseas-born Australian-trained health professionals were invited to participate in this qualitative study using snowball sampling. The interviews were recorded with the approval of the participants. The interview data were transcribed as raw data and later coded for thematic analysis, which includes topics and themes arising from the raw data as well as from the interview questions with a focus on issues and strategies of acculturation into a rural health context.

Results/conclusion
There were different factors which facilitated or hindered the acculturation of overseas-born health professionals into a rural workforce such as professional isolation, cultural shock, family pressure, and cultural identity. The acculturation process was also affected by the quality of their perceived ‘social and cultural capital’. Different coping strategies were employed to deal with the changes in a new rural environment. The paper discusses some implications of this study with focus on how to improve the living and working conditions of overseas-born Australian-trained health professionals in order to attract them to rural Australia.