Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments.

Executive summary Objective: The aims of this study were to identify the impact of Pandemic (H1N1) 2009 Influenza on Australian Emergency Departments (EDs) and their staff, and to inform planning, preparedness, and response management arrangements for future pandemics, as well as managing infectious patients presenting to EDs in everyday practice. Methods This study involved three elements: 1. The first element of the study was an examination of published material including published statistics. Standard literature research methods were used to identify relevant published articles. In addition, data about ED demand was obtained from Australian Government Department of Health and Ageing (DoHA) publications, with several state health departments providing more detailed data. 2. The second element of the study was a survey of Directors of Emergency Medicine identified with the assistance of the Australasian College for Emergency Medicine (ACEM). This survey retrieved data about demand for ED services and elicited qualitative comments on the impact of the pandemic on ED management. 3. The third element of the study was a survey of ED staff. A questionnaire was emailed to members of three professional colleges—the ACEM; the Australian College of Emergency Nursing (ACEN); and the College of Emergency Nursing Australasia (CENA). The overall response rate for the survey was 18.4%, with 618 usable responses from 3355 distributed questionnaires. Topics covered by the survey included ED conditions during the (H1N1) 2009 influenza pandemic; information received about Pandemic (H1N1) 2009 Influenza; pandemic plans; the impact of the pandemic on ED staff with respect to stress; illness prevention measures; support received from others in work role; staff and others’ illness during the pandemic; other factors causing ED staff to miss work during the pandemic; and vaccination against Pandemic (H1N1) 2009 Influenza. Both qualitative and quantitative data were collected and analysed. Results: The results obtained from Directors of Emergency Medicine quantifying the impact of the pandemic were too limited for interpretation. Data sourced from health departments and published sources demonstrated an increase in influenza-like illness (ILI) presentations of between one and a half and three times the normal level of presentations of ILIs. Directors of Emergency Medicine reported a reasonable level of preparation for the pandemic, with most reporting the use of pandemic plans that translated into relatively effective operational infection control responses. Directors reported a highly significant impact on EDs and their staff from the pandemic. Growth in demand and related ED congestion were highly significant factors causing distress within the departments. Most (64%) respondents established a ‘flu clinic’ either as part of Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. the ED operations or external to it. They did not note a significantly higher rate of sick leave than usual. Responses relating to the impact on staff were proportional to the size of the colleges. Most respondents felt strongly that Pandemic (H1N1) 2009 Influenza had a significant impact on demand in their ED, with most patients having low levels of clinical urgency. Most respondents felt that the pandemic had a negative impact on the care of other patients, and 94% revealed some increase in stress due to lack of space for patients, increased demand, and filling staff deficits. Levels of concern about themselves or their family members contracting the illness were less significant than expected. Nurses displayed significantly higher levels of stress overall, particularly in relation to skill-mix requirements, lack of supplies and equipment, and patient and patients’ family aggression. More than one-third of respondents became ill with an ILI. Whilst respondents themselves reported taking low levels of sick leave, respondents cited difficulties with replacing absent staff. Ranked from highest to lowest, respondents gained useful support from ED colleagues, ED administration, their hospital occupational health department, hospital administration, professional colleges, state health department, and their unions. Respondents were generally positive about the information they received overall; however, the volume of information was considered excessive and sometimes inconsistent. The media was criticised as scaremongering and sensationalist and as being the cause of many unnecessary presentations to EDs. Of concern to the investigators was that a large proportion (43%) of respondents did not know whether a pandemic plan existed for their department or hospital. A small number of staff reported being redeployed from their usual workplace for personal risk factors or operational reasons. As at the time of survey (29 October –18 December 2009), 26% of ED staff reported being vaccinated against Pandemic (H1N1) 2009 Influenza. Of those not vaccinated, half indicated they would ‘definitely’ or ‘probably’ not get vaccinated, with the main reasons being the vaccine was ‘rushed into production’, ‘not properly tested’, ‘came out too late’, or not needed due to prior infection or exposure, or due to the mildness of the disease. Conclusion: Pandemic (H1N1) 2009 Influenza had a significant impact on Australian Emergency Departments. The pandemic exposed problems in existing plans, particularly a lack of guidelines, general information overload, and confusion due to the lack of a single authoritative information source. Of concern was the high proportion of respondents who did not know if their hospital or department had a pandemic plan. Nationally, the pandemic communication strategy needs a detailed review, with more engagement with media networks to encourage responsible and consistent reporting. Also of concern was the low level of immunisation, and the low level of intention to accept vaccination. This is a problem seen in many previous studies relating to seasonal influenza and health care workers. The design of EDs needs to be addressed to better manage infectious patients. Significant workforce issues were confronted in this pandemic, including maintaining appropriate staffing levels; staff exposure to illness; access to, and appropriate use of, personal protective equipment (PPE); and the difficulties associated with working in PPE for prolonged periods. An administrative issue of note was the reporting requirement, which created considerable additional stress for staff within EDs. Peer and local support strategies helped ensure staff felt their needs were provided for, creating resilience, dependability, and stability in the ED workforce. Policies regarding the establishment of flu clinics need to be reviewed. The ability to create surge capacity within EDs by considering staffing, equipment, physical space, and stores is of primary importance for future pandemics.

Rights versus reality : the difficulty of providing 'access to English' in Queensland Courts

This report was developed out of a Legal Practitioner on Trust Account Fund grant from the Department of Justice and Attorney-General in Queensland, to review the Aboriginal English in the Courts Handbook. Judges, Magistrates, barristers and court staff were interviewed about the Handbook. The findings extend beyond Aboriginal English into access to English in Queensland Courts. Recommendations are made about language difficulties faced by witnessed and the ability to the courts to respond to them.

Who has rights to what? Inclusion in Australian early childhood programs

In early childhood settings prior to school and in the early years of primary school, debate continues over the meaning of inclusion and its scope in terms of the groups under consideration. The genealogies of early childhood education and care, early primary school, special education and cultural education were examined to identify recurring and emerging approaches to inclusion within Australian programs for children aged birth to eight years. Approaches to inclusion encompassing multiple forms of diversity co-exist in the Australian educational literature with targeted approaches focused on disabilities or risk. These differing approaches reflect underlying ideological divisions and varying assumptions about diversity. Multiple approaches, including the expansion of early childhood services, reflect tensions over children’s rights, conceptualisations of inclusion, expectations of teachers, system coordination, economic constraints and political pressure to cater for a complex range of young children in varied settings. The paper incorporates discussion on underlying philosophical tensions within the early childhood field.

Safety in occupational driving : development of a driver behaviour scale for the workplace context

International statistics indicate that occupational, or work-related driving, crashes are the most common cause of workplace injury, death, and absence from work. The majority of research examining unsafe driver behavior in the workplace has relied on general road safety questionnaires. However, past research has failed to consider the organizational context in the use of these questionnaires, and as such, there is ambiguity in the dimensions constituting occupational driving. Using a theoretical model developed by Hockey (1993, 1997), this article proposes and validates a new scale of occupational driver behavior. This scale incorporates four dimensions of driver behavior that are influenced by demanding workplace conditions; speeding, rule violation, inattention, and driving while tired. Following a content validation process, three samples of occupational drivers in Australia were used to assess the scale. Data from the first sample (n=145) were used to reduce the number of scale items and provide an assessment of the factorial validity of the scale. Data from the second sample (n=645) were then used to confirm the factor structure and psychometric properties of the scale including reliability and construct validity. Finally, data from the third sample (n=248) were used to establish criterion validity. The results indicated that the scale is a reliable and valid measure of occupational driver behavior.

Longitudinal modelling of the influence of individual differences and the workplace on well-being and work engagement

A set of non-nested longitudinal models tested the relationships between personal and workplace resources, well-being and work engagement. The reciprocal model, trimmed of trivial paths had the best fit and parsimony. The model showed the strong influences of concurrent functioning, stability of variables over time and weaker reciprocal relationships between variables across time. Individuals with greater confidence in themselves and the future experience better work conditions and have greater well-being and work engagement. These day-to-day influences are equalled by the long term strength and stability of Individual Factors, Positive Workplace Factors, and Overall Well-Being. Whilst the reciprocal paths had only weak to mild effects, there was mutual reinforcement of Individual Factors and Overall Well-Being, with Positive Workplace Factors and Work Engagement counterbalancing each other, indicating a more complex relationship. Well-being, particularly, is anchored in the immediate and distant past and provides a robust stability to functioning into the future.

Empirical basis for adopting a theory-driven approach to preventing alcohol and other drug impairment (AOD) in the workplace

Background: A State-based industry in Australia is in the process of developing a programme to prevent AOD impairment in the workplace. The objective of this study was to determine whether the Theory of Planned Behaviour can help explain the mechanisms by which behaviour change occurs with regard to AOD impairment in the workplace. ---------- Method: A survey of 1165 employees of a State-based industry in Australia was conducted, and a response rate of 98% was achieved. The survey included questions relevant to the Theory of Planned Behaviour: behaviour; behavioural intentions; attitude; perceptions of social pressure; and perceived behavioural control with regard to workplace AOD impairment. ---------- Findings: Less than 3% of participants reported coming to work impaired by AODs. Fewer than 2% of participants reported that they intended to come to work impaired by AODs. The majority of participants (over 80%) reported unfavourable attitudes toward AOD impairment at work. Logistic regression analyses suggest that, consistent with the theory of planned behaviour: attitudes, perceptions of social pressure, and perceived behavioural control with regard to workplace AOD impairment, all predict behavioural intentions (P < .001); and behavioural intentions predict (self-reported) behaviour regarding workplace AOD impairment (P < .001). ---------- Conclusions: The Theory of Planned Behaviour appears to assist with understanding the mechanisms by which behaviour change occurs with regard to AOD impairment in the workplace. An occupational AOD programme which targets those mechanisms for change may improve its impact in preventing workplace AOD impairment.

Workplace emotion : fear and anger

This original screen drama functioned as the stimulus in an audience response experiment, undertaken as part of research into workplace emotion. Commissioned and scripted by researchers at the University of Queensland and Griffith University, the film portrays the same narrative (a workplace conflict) twice, but played differently each time. The first version is intended to evince in viewers a fear response, and the second, an anger response. In preparing and rehearsing their performance choices, the actors utilised established taxonomies of fear and anger, in order to produce the optimum stimulus for conducting the experiment.

New media pathways : navigating the links between home, school and the workplace

The terms ‘literacy’ and ‘technology’ remain highly contentious within the field of education. What is meant by ‘literacy’ and the methods used to measure it vary quite markedly in educational and historical contexts across the world. Similarly, while there is a shared concern to research the potential impact of new information and communication technologies (ICTs) on patterns of teaching and learning, there are major discrepancies about which aspects and uses of these technologies should be incorporated into formal learning environments and how this can be accomplished. While government policy makers tend to regard ICTs in relation to ideas of ‘smartness’, efficiency, and the ‘knowledge’ (or ‘new’) economy, educators and educational researchers promote them as offering new tools for learning and critical thinking and the development of new literacies and socio-cultural identities. This clearly has ramifications for the ways literacy is taught and conceptualised throughout the years of schooling, K-12. Outside school, meanwhile, students engage with ICTs on another level entirely, as tools for the maintenance of social networks, for leisure, and for learning and participating in the cultures of their peers. Whatever the differences in perspective, it remains the case that a society’s dominant understandings about literacy and technology will have significant implications for the development of school curriculum.

Development of a workplace wellness promotion pilot framework : a case study of the Blue Care Staff Wellness Program

Workplace wellness initiatives are currently unreflective of the multidimensional and holistic nature of the wellness construct. There exists an opportunity for promoters of health to move toward models of workplace wellness promotion that more fully appreciate the interconnected nature of health dimensions and promote them even-handedly. The Blue Care Staff Wellness Program framework was developed in response to a recognised need for consistent and wellness-focused constructs for workplace wellness promotion and dissemination. The framework promotes and supports the individual and organisational wellness of the Blue Care employee population by providing a comprehensive and sustainable employee wellness program. This has been achieved by the adoption of consistent wellness principles to guide the framework conception and theory based development. The use of the framework in a pilot program will provide insight into the frameworks effectiveness in promoting a comprehensive workplace wellness program, and go further to establish the relationship between wellness and productivity in the workplace.

Adult learning in a workplace context

In light of the changing nature of contemporary workplaces, this chapter attempts to identify employer expectations and the associated skills required to workers to function effectively in such workplaces. Workers are required to participate in informed discussion about their specific jobs and to contribute to the overall development of organisations. This requires deep understanding of domain-specific knowledge, which at times can be very complex. Workers are also required to take responsibility for their actions and are expected to be flexible so that they can be deployed to other related jobs depending on demand. Finally, workers are expected to be pro-active, be able to anticipate situations and continuously update their knowledge to address new situations. This chapter discusses the nature of knowledge and skills that will facilitate the above qualities.

Sacked! Workplace dismissals amongst youth employees

Limited academic attention has been afforded to young workers relative to their adult counterparts. This study addresses a phase of the employment relationship for young people that is very infrequently examined - during or around the time when the relationship ends. It examines the relative frequency of different forms of dismissal and the circumstances preceding the dismissals via a content analysis of 1259 cases of employee enquiries to a community advocacy organisation in Australia. Results indicate that dismissal was most commonly associated with bullying, harassment, and taking personal leave. Young men, compared to young women, were disproportionately likely to report allegations of misconduct as preceding dismissal, while females experienced higher rates of sexual harassment and discrimination. The research highlights the types and circumstances of dismissal across a range of employment contexts and reveals the complexities of youth employment relationships which may differ from those of the general workforce.

Workplace sexual harassment 30 years on : a review of the literature

Despite its proscription in legal jurisdictions around the world, workplace sexual harassment (SH) continues to be experienced by many women and some men in a variety of organizational settings. The aims of this review article are threefold: first, with a focus on workplace SH as it pertains to management and organizations, to synthesize the accumulated state of knowledge in the field; second, to evaluate this evidence, highlighting competing perspectives; and third, to canvass areas in need of further investigation. Variously ascribed through individual (psychological or legal consciousness) frameworks, sociocultural explanations and organizational perspectives, research consistently demonstrates that, like other forms of sexual violence, individuals who experience workplace SH suffer significant psychological, health- and job-related consequences. Yet they often do not make formal complaints through internal organizational procedures or to outside bodies. Laws, structural reforms and policy initiatives have had some success in raising awareness of the problem and have shaped rules and norms in the employment context. However, there is an imperative to target further workplace actions to effectively prevent and respond to SH.

School-aged workers : industrial citizens in the making?

While the literature points to significant shifts in young peoples‟ labour market participation and the social, economic and political context in which the shift has occurred, it tells us little about how young people are socialised in the workplace, how literate they are in terms of their rights and responsibilities at work or how and via what mechanisms this literacy is acquired. Using the concept citizenship as an analytical tool, we explored these questions using data derived from 48 focus groups conducted with 216 adolescents (13-16 years of age) at 19 high schools in Australia. The findings reveal the way in which several key dimensions of industrial citizenship come to be shaped and have implications for addressing the vulnerability of youth in employment and informing policy and action.