How do critical care nurses define the discharge planning process?

Background: Professional, political and organisational factors have focused attention on the discharge planning process in the Victorian health care sector. Discharge planning for patients, as part of continuity of care, is seen as a key concept in the delivery of nursing care. However, there is no question that discharge planning has emerged as a complex area of practice, and is, perhaps, most complex in the critical care area.

Aim: The study reported here is part of a larger thesis exploring critical care nurses’ perceptions and understanding of the discharge planning process in the health care system in the state of Victoria, Australia. As part of the survey participants were asked to define discharge planning as it related to the critical care environment in which they worked.

Methods: Utilising an exploratory descriptive approach, 502 Victorian critical care nurses were approached to take part in the study. The resultant net total of 218 participants completed the survey, which represented a net response rate of 43.4%. The data were analysed using quantitative and qualitative methodologies.

Findings: Three common themes emerged. A significant number of participants did not believe that discharge planning occurred in critical care, and therefore, thought that they could not provide a definition. There was uncertainty as to what the discharge planning process actually referred to in terms of discharge from critical care to the general ward or discharge from the hospital. There was an emphasis on movement of the patient to the general ward, which was considered in three main ways by first, getting the patient ready for transfer; second, ensuring a smooth transition to the ward and third, transfer of the patient to the ward often occurred because the critical care bed was needed for another patient.

Conclusion: The findings presented here suggest at a nursing level, the discharge planning process is not well understood and some degree of mutual exclusivity still remains. There is a need for further education of critical care nurses with regard to the underlying principles of the discharge planning process.

Critical care nurses' beliefs about discharge planning process: a questionnaire survey

Aim: To report on the beliefs of critical care nurses with regard to the discharge planning process, in Victoria, Australia.

Methods: An exploratory descriptive design was used. A total of 502 Victorian critical care nurses were approached to take part in the study. A total of 218 eligible participants completed the survey, which represented a nett response rate of 43.4%. The data were analysed using descriptive statistics.

Results: The current discharge planning processes are ad hoc and influenced by patient acuity. Critical care nurses believe that workload issues, unplanned discharges and inadequate communication contribute to difficulties implementing the discharge plan.

Co-ordination of the discharge planning process in critical care

Aim and objectives: This article reports on the current discharge planning beliefs in relation to the co-ordination of the discharge planning process in the critical care environment in the health care system in the state of Victoria, Australia. As there is a paucity of previous studies examining discharge planning in critical care nursing knowledge about the phenomena is consequently limited. Background: The study reported here is part of a larger study exploring critical care nurses' perceptions and understanding of the discharge planning process in the health care system in the state of Victoria, Australia. While a number of different discharge planning models are reported in the literature there is no agreement on the most effective or the most efficient model. Design: An exploratory descriptive research design was used for this study. Methods: A total of 502 Victorian critical care nurses were approached to take part in the study. A total of 218 participants completed the survey, which represented a nett response rate of 43·4%. The data from the questionnaire were entered into the Statistical Package for Social Sciences (SPSS) Base 10.0. This allowed calculation of descriptive statistics and statistical analysis using chi-square test for goodness-of-fit.  Results: While just over half the participants reported that the discharge planning process in their unit was co-ordinated by a combination of personnel that included a nurse, just under half the participants believed that this was an appropriate model. Another key finding was of those participants who worked in critical care units using primary nursing, just over half responded that the bedside nurse/primary nurse co-ordinated the discharge planning process while just under half responded that a combination of health care team members, including a nurse, co-ordinated the process. Overall there was little support for the designated discharge planning nurse to co-ordinate the process. Conclusions: The findings presented here suggest critical care nurses need to examine who has the ultimate responsibility of co-ordinating the critical care patient's discharge plan irrespective of the nursing model employed within the critical care ward. There is the need to ensure that when discharge planning becomes everybody's responsibility it ultimately does not become no-one's responsibility. Relevance to clinical practice: If discharge planning practices are to be changed with the introduction of new discharge planning models in the critical care environment then it is important not only to know current practice but also the perceptions of critical care nurses in terms of who they believe should co-ordinate the discharge planning process.

Stakeholder involvement in the public planning process : the case of the proposed 12 apostles visitor centre

A range of stakeholders should inform planning processes if these processes are to be consistent with best practice principles. This paper examines the case of the 12 Apostles Visitor Centre, a tourism development which was proposed to be located in a National Park in Victoria, Australia. Limited opportunities were provided for meaningful stakeholder input during the planning phase. Despite the prevailing view amongst all major parties that some development of facilities would be appropriate, an absence of genuine consultation was experienced prompting a substantial redesign of the development concept as originally conceived (in 1996) and to project delays which postponed the commencement of the development into 2000 by which time a new State Government was in place.

The theory and practice of coastal area planning: linking strategic planning to local communities

Integrated coastal management (ICM) has been slowly accepted over the last decade as a unifying approach for coastal planning and management throughout the world. Coastal planning aimed at achieving the objectives of ICM can be implemented by varying processes and faces many challenges. One major challenge for coastal planning is to adapt the well-developed theoretical principles of ICM to practical and understandable outcomes in local areas. Associated with this challenge is the need to balance coastal planning objectives for conservation and economic development of a nation or state/province with the objectives of the local community. This article describes a three-tiered approach to coastal planning in Victoria, Australia, which will be of value to other countries, particularly those with subnational coastal planning jurisdictions. This approach not only has the aim of balancing subnational (e.g., state government) and local objectives, but also of applying the theoretical concept of ICM in practice on the ground. In addition, the approach sets out to achieve a sense of ownership of the planning process by local communities by maximizing their involvement at all levels of planning and also by making the state strategy as easy to understand and follow as possible.

Nurses' perceptions of discharge planning

The present paper investigates what the term discharge planning actually means to nurses working in the acute care environment. A qualitative approach was used for this study. Twelve volunteer registered nurses (RNs) working in a large metropolitan Victorian public hospital were interviewed. All participants stated emphatically that they were involved in the discharge planning process although differing levels of involvement existed. ‘Organizing’ and ‘planning’ were key words used by participants to define the term discharge planning. All but one participant considered the nurse to be the coordinator of the discharge planning process. How participants communicated with other nursing staff regarding the discharge planning needs of individual patients depended on the policy of each individual ward. Communication was perceived to be a major factor that either enhanced or impeded the discharge planning process.

Factors that enhance or impede critical care nurses' discharge planning practices

Introduction:
Any illness that is serious enough to require admission to the critical care unit will intensify the physical and psychological effects that the patient and their significant others experience. Hence, the discharge needs of patients admitted to critical care are unquestionably complex, diverse and dynamic.

Methods:
Utilising an exploratory descriptive approach 502 critical care nurses, identified from the Australian College of Critical Care Nursing (ACCCN) (Victoria) database were invited to participate in this study. A 31-item questionnaire was developed and distributed. A total of 218 eligible participants completed the survey. One-to-one semi-structured interviews with 13 Victorian critical care nurses were also conducted.

Results:
Participants reported that a lack of time was a barrier to discharge planning. Communication however, could enhance or impede the discharge planning process in critical care. Participants considered that the critical pathway, used in the care of cardiothoracic patients, did assist with communication of discharge planning processes, hence enhancing the process.

Conclusions:
While these findings provide some understanding of the factors that enhanced or impeded critical care nurses’ discharge planning practices further research is indicated. The findings reported here may, however, provide a starting point for improving the discharge planning process in critical care.

Marketing planning and business performance : an empirical study of large Australian organisations

The marketing planning process is said to influence organisational performance. This influence is realised through the adoption of a focused approach aimed at achieving specific marketing objectives, which motivates the adaptation of the internal capabilities of an organisation in facilitating an effective implementation. This study investigated the association of formal marketing planning with business performance. The results showed that marketing planning has a stronger, positive relationship with market share, than with the overall financial performance of the organisation. The study also compared the associations of marketing planning and market orientation variables with the performance measures. The results indicated that the two variables associate at about the same magnitude with market share and the overall financial performance.

Seeking mechanisms for improved integration of biodiversity issues in regional natural resource management planning

This article reviews the literature on natural resource management (NRM) planning in Australia, with particular consideration given to exploring how regions might better integrate biodiversity conservation into catchment or regional planning in ways that lead to improved biodiversity conservation practice in the field. Many of the findings of the review are generic, affecting a range of NRM issues (including biodiversity conservation) and the NRM planning process itself, whilst other findings are specific to conservation of biodiversity. Factors affecting the integration of biodiversity include the organizational characteristics of the regional NRM body, clarity in the region of the responsibilities across the three tiers of government, effective participation of stakeholders, existence of detailed NRM plans that include sound biodiversity data and management principles, access to interpreted information, use of a mix of policy instruments capable of delivering biodiversity goals, and effective monitoring frameworks and tools to track the return on investment. there is considerable variability in the ways that NRM planning is practiced across Australia, at the enterprise, regional or catchment levels. However, an overarching issue is how well the planning caters for differences across space, time and human values and this article attempts to identify the considerations that impact on that requirement.

Virtual Werribee : a planning support tool

Virtual Werribee is collaborative research in applying 3-D modelling and visualisation as a planning support tool in comparison to 2-D plans and drawings. It was a joint initiative involving Deakin University and the Wyndham City Council to demonstrate the use of 3-D visualisation for planning process in the actual context of a planning authority in Australia. The objective of this project was to assist the council in preparing for the revised Local Structure Plan. By reconstructing the council’s data into easily understood information, 3-D model and visualisation served as a verification and discussion tool for decision making. The integration of wider site context also provided a better understanding of the surrounding development areas. This could equip other stakeholders as well as the community to participate in council’s planning agenda activities, such as increasing the urban density and building heights limit.

Virtual Werribee included the development planning agenda, categorised as new, re-development and hypothetical. The modelling process progressed with sufficient data from the council. Some changes to the initial plan were made, including the use of CAD modelling software instead of GIS software, and production of a block model with selected detail buildings, instead of a full draped 3-D model. The council decided that the block model would be sufficient for their planning purposes. This was determined while taking into consideration the available facilities at the council.

The potentials of the model as a planning tool were demonstrated in this paper, and further compared to the council’s existing materials prepared by the project developers. The advantages of the 3-D interactive model and visualisation over the conventional materials have provided the council officer with a tool for better empowerment in the planning process. This was also evident in the increasing engagement level between the officer and the model as the process developed. As a result of this, the project scope has also expanded, finally covering the entire city.

While Virtual Werribee has the potential to better communicate council’s planning agendas to the stakeholders and the community, the key factor, coupled with its visualisation components, was its interactive capability. Property layers with aerial site image that provided a realistic background served as a virtual city platform for different users. Although limited in its analytic capability found in GIS software, this model offered high visualisation content to assist visual impact assessment through its interactive mode along with a series of still images and a simulation movie.

Planning with events and states

We present an overall planning system in which specifications can be described in terms of events and states. The underlying feature of this system is temporal logic, and its expressive power alloys one to deal with simultaneous actions and interacting actions. Moreover, one can represent both goal-oriented positive constraints and prevention-oriented negative constraints. The planning system can generate hierarchical plans and the overall model is capable of handling interacting agents.

Adaptation planning for coastal inundation and erosion at the local level : a knowledge systems perspective

Scientific projections for climate change induced sea level rise highlight the potential for serious consequences in low lying coastal areas, through impacts upon: built infrastructure; beneficial uses; and ecological values. An area of particular concern relates to the ways in which issues associated with land may be subject to future inundation and, or, erosion. Responding to such issues is complex and challenging, requiring consideration of multiple sources of evidence (with varying levels of certainty), diverse organisational settings and priorities, and multiple perspectives on what the evidence means. Further, limited attention has been directed towards exploring the knowledge dynamics associated with coastal adaption planning. In this paper we explore the knowledge dynamics associated with coastal adaption planning, in order to highlight the inter-organisational and inter-personal challenges involved. We do so by drawing on the views expressed in semi structured interviews by stakeholders with an interest in coastal climate change. The particular focus is on exploring how different actors perceive coastal adaption planning process, and the tensions, challenges, and implications associated with, and arising from, the way in which coastal adaptation knowledge is exchanged.

Long-term water supply planning in an Australian coastal city : Dams or desalination?

Water resource managers and planners are continually involved in defining and evaluating alternative policies to better meet changing water supply conditions and the expectations of society. To undertake such long-term water supply planning, this study developed a novel integrated system dynamics model to combine economic, social and scientific variables and considerations within the planning horizon. Extensive sensitivity analysis for these variables was considered in this long term water resource planning process. The analysis suggests that over a longer time horizon, desalination provides a more viable, cost effective and secure bulk water supply alternative when compared to building large rain-dependent dams.

School innovation in science: transformative initiatives in Victorian secondary schools

The School Innovation in Science intiative is operating in more than 300 schools in Victoria. It has achieved considerable success in transforming science teaching and learning in primary and secondary schools. This paper describes the core elements of SIS, and provides an overview of the different types of initiatives pursued by secondary schools arising out of an action planning process. case studies of initiatives illustrate the richness and range of innovation in schools. It is argued that the SIS model provides the conditions for deep seated change and innovation in schools' science programs.

From policy to practice: the development of an integrated health promotion plan for children's services at Plenty Valley Community Health Inc.

Current changes in the funding of health promotion in community health in Victoria require community health agencies to integrate health promotion with service delivery. This provides both opportunities and challenges for community health staff. Members of the Children’s Service Team at Plenty Valley Community Health Inc. addressed these changes by developing an integrated health promotion plan. The approach used involved identifying client pathways and then integrating opportunities for health promotion interventions into these pathways. Staff perceptions of the process involved in developing the plan were examined. The use of client pathways to integrate health promotion into everyday practice proved a successful approach for members of the Children’s Services Team, and provides a useful model for health promotion planning in community health that helps staff to see the relevance of health promotion to their practice, and engages staff in the planning process. Members of the Children’s Services Team reported that the process involved in developing their integrated health promotion plan was a very worthwhile experience that allowed them a strong sense of ownership of the plan.