Hospital in the home: constructions of the nursing role - a literature review

• Acute medical and nursing treatment in the home is increasingly seen as an alternative to hospitalization. Models such as hospital in the home (HITH) or acute home care are said to provide a safe, comfortable environment for patients that is conducive to healing.

• A review of the literature reveals the embryonic nature of the research and discussion related to this alternative care delivery model. In general, the benefits of hospital in the home programmes are presented in an uncritical manner.

• Medical practitioners have embraced the move to home care as a means of expanding the use of advanced technologies and improved drug regimes beyond the hospital walls.

• The nursing response has been mechanistic and recipe-like while advancing the HITH nursing role as an opportunity for speciality practice by virtue of the increased autonomy and independence required.

• This review demonstrates the influence of a professional mandate for specialization, and the ideological and scientific interests that have influenced the role of the nurse.

Home range of the squirrel glider (Petaurus norfolcensis) in a network of remnant linear habitats

Linear strips of natural or semi-natural vegetation are a characteristic feature of rural landscapes throughout the world. Their value for the conservation of fauna in heavily modified landscapes depends on the response of species to the linear shape of the habitat, and the pressures this imposes on population processes and spatial organization. In south-eastern Australia, woodland habitats occupied by the squirrel glider Petaurus norfolcensis, a threatened species of arboreal marsupial, have been preferentially cleared for agriculture leaving only remnants within cleared farmland. In this study, the home range of P. norfolcensis was investigated by radio-tracking 40 gliders within a highly modified landscape where the majority (83%) of remaining wooded habitat occurs as a network of linear strips along roadsides and streams. Individuals were tracked for one to four seasons, resulting in the collection of 4213 independent locational 'fixes'. All fixes of animals were from remnant woodland. Home ranges were elongated and linear, primarily determined by the shape and arrangement of woodland habitat. Seasonal home ranges were small (mean of 1.4–2.8 ha) and ranged between 320 and 840 m long. Small patches of trees in farmland adjacent to the linear habitats were also extensively used. Despite the highly modified landscape structure, home ranges of P. norfolcensis in the linear network were smaller than those estimated from other studies of this species in continuous habitat. The apparent high quality of the linear habitats is attributed to the density of large old trees, which provide foraging and breeding resources, and the productivity of the environment. Linear landscape elements may have a valuable conservation function where they provide resident habitat or enhance landscape connectivity, but their long-term viability is vulnerable to disturbance.

Multisensory environments for leisure: promoting well-being in nursing home residents with dementia

Multisensory environments such as Snoezelen^® rooms are becoming increasingly popular in health care facilities for older individuals. There is limited reliable evidence of the benefits of such innovations, and the effect they have on residents, caregivers, and visitors in these facilities. This two-stage project examined how effective two types of multisensory environments were in improving the well-being of older individuals with dementia. The two multisensory environments were a Snoezelen room and a landscaped garden. These environments were compared to the experience of the normal living environment. The observed response of 24 residents with dementia in a nursing home was measured during time spent in the Snoezelen room, in the garden, and in the living room. In the second part of the project, face-to-face interviews were conducted with six caregivers and six visitors to obtain their responses to the multisensory environments. These interviews identified the components of the environments most used and enjoyed by residents and the ways in which they could be improved to maximize well-being.

Children's perceptions of their home and neighborhood environments, and their association with objectively measured physical activity: A qualitative and quantitative study

Environmental factors may have an important influence on children’s physical activity, yet children’s perspectives of their home and neighborhood environments have not been widely assessed. The aim of this study was to investigate children’s perceptions of their environments, and to examine associations between these perceptions and objectively measured physical activity. The sample consisted of 147, 10-year-old Australian children, who drew maps of their home and neighborhood environments. A subsample of children photographed places and things in these environments that were important to them. The maps were analyzed for themes, and for the frequency with which particular objects and locations appeared. Physical activity was objectively measured using accelerometers. Six themes emerged from the qualitative analysis of the maps and photographs: the family home; opportunities for physical activity and sedentary pursuits; food items and locations; green space and outside areas; the school and opportunities for social interaction. Of the 11 variables established from these themes, one home and two neighborhood factors were associated with children’s physical activity. These findings contribute to a broader understanding of children’s perceptions of their environment, and highlight the potential importance of the home and neighborhood environments for promoting physical activity behavior.

Association of family environment with children's television viewing and with low level of physical activity

Objective: This study examined associations between the family environment and children's television (TV) viewing and likelihood of being low-active.
Research Methods and Procedures: In 2001, children were recruited from 19 primary schools in Melbourne, Australia. Parents completed a questionnaire about their child's TV viewing and the family environment. Children also completed a questionnaire and wore an accelerometer for 8 days. Movement counts were used to identify low-active children (lowest quartile). Data were analyzed in May 2004.
Results: The sample consisted of 878 children (mean age = 11.5 0.6 yrs). Multiple logistic regression revealed that socioeconomic status [adjusted odds ratios (AOR) = 0.4 boys], frequency families watched TV together (AOR = 2.0 boys), mothers' (AOR = 1.8 boys; AOR = 2.5 girls) and fathers' (AOR = 2.6 boys; AOR = 2.8 girls) TV viewing, and rules prohibiting TV during mealtimes (AOR = 0.6 boys; AOR = 0.6 girls) related to children watching TV 2 h/d. Variables associated with low-level physical activity included self-reported enjoyment of Internet use (AOR = 1.7 boys) and preference for watching TV (AOR = 2.3 girls), perception that mother uses computer a lot (AOR = 1.9 boys) and likes using the computer (AOR = 0.6 girls), fathers' reported computer/electronic games use (AOR = 1.7 girls), frequency families used computer together (AOR = 0.4 girls), rules that TV viewing must be supervised (AOR = 1.9 boys; AOR = 0.6 girls), and having pay TV (AOR = 0.6 boys) and electronic games at home (AOR = 2.6 boys).
Discussion: These findings suggest that the relationships between the family environment and TV viewing and low-level activity are complex and that these behaviors are distinct.

Adolescent home food environments and socioeconomic position

Many adolescents have diets that are less than optimal, particularly adolescents of low socioeconomic position (SEP). The determinants of SEP differences in adolescent dietary intake are poorly understood. This study examined the home food environments of adolescents and specifically investigated whether low SEP adolescents have less supportive home local environments, fewer eating rules and poorer home availability of fruit and vegetables than adolescents of high SEP. A cross-sectional, self-reported survey was administered to 3,264 adolescents in years 7 and 9, from 37 secondary schools in Victoria, Australia. Adolescent perceptions of the home meal environment, eating rules and home food availability were described and compared across SEP, which was measured using maternal education. Maternal education was linked to various aspects of the home meal environment, as well as home food availability, but not to eating rules. Low SEP adolescents were more likely to report that they were always allowed to watch television during meal times, and that unhealthy foods were always or usually available at home. In contrast, high SEP adolescents were more likely to report that vegetables were always served at dinner, that the evening meal was never an unpleasant time and always or usually a time for family connectedness, and that fruit was always or usually available at home. This study highlights aspects of the home food environment that might explain SEP variation in adolescent diets. Feasible ways of increasing home availability of healthy foods, and encouraging home meal environments to be supportive of healthy eating should be explored, particularly in households of low SEP adolescents.

The tri-focal model of care : Advancing the teaching-nursing home concept

Providing residential aged care is challenging because of the complexity of residents' health status, difficulties recruiting and retaining skilled staff, and financial and regulatory constraints. This paper discusses some of these challenges and describes an innovative model of care, termed 'The Tri-focal model of care'. This model was developed based on the concepts of 'partnership-centred care', 'positive work environment' and the need for evidence-based practice to underpin all aspects of care. It is envisaged that the implementation of this model will provide a rich learning environment that advances the teaching-nursing home concept and the quality of residential aged care.

Children's fruit and vegetable intake : Associations with the neighbourhood food environment

Objective : To examine associations between availability of different types of food outlets and children's fruit and vegetable intake.
Method : Parents of 340 5–6 and 461 10–12 year-old Australian children reported how frequently their child ate 14 fruits and 13 vegetables in the last week in 2002/3. A geographic information system (GIS) was used to determine the availability of the following types of food outlets near home: greengrocers; supermarkets; convenience stores; fast food outlets; restaurants, cafés and takeaway outlets. Logistic regression analyses examined the likelihood of consuming fruit ≥ 2 times/day and vegetables ≥ 3 times/day, according to access to food outlets.
Results : Overall, 62.5% of children ate fruit ≥ 2 times/day and 46.4% ate vegetables ≥ 3 times/day. The more fast food outlets (OR = 0.82, 95%CI = 0.67–0.99) and convenience stores (OR = 0.84, 95%CI = 0.73–0.98) close to home, the lower the likelihood of consuming fruit ≥ 2 times/day. There was also an inverse association between density of convenience stores and the likelihood of consuming vegetables ≥ 3 times/day (OR = 0.84, 95%CI = 0.74–0.95). The likelihood of consuming vegetables ≥ 3 times/day was greater the farther children lived from a supermarket (OR = 1.27, 95%CI = 1.07–1.51) or a fast food outlet (OR = 1.19, 95%CI = 1.06–1.35).
Conclusion : Availability of fast food outlets and convenience stores close to home may have a negative effect on children's fruit and vegetable intake.

Longitudinal examination of the family food environment and weight status among children

Objective. To examine whether aspects of the family food environment were associated with body mass index (BMI) z-score and weight status in children, cross-sectionally and prospectively over 3 years.

Methods. Four aspects of the family food environment (breakfast eating patterns, food consumption while watching television, parental provision of energy-dense foods and child consumption of energy-dense food at home and away from home) were assessed with a questionnaire completed by parents of 161 children aged 5-6 years and 132 children aged 10-12 years in Melbourne, Australia in 2002/03. In 2002/03 and 2006, children's BMI z-score and weight status (non-overweight or overweight) was calculated from measured height and weight. Results. At baseline, 19% of younger and 21% of older children were overweight. Three years later, a greater proportion of younger (now aged 8-9 years) compared with older (aged 13-15 years) children were classified as overweight (28% versus 18%). Few of the family food environment variables were associated with children's BMI z-score and weight status cross-sectionally and longitudinally. However, among older children, more frequent dinner consumption while watching television was associated with a higher BMI z-score longitudinally (B = 0.3, 95% CI = 0.0, 0.6), less frequent breakfast consumption was associated with higher odds of overweight longitudinally (OR = 2.2, 95% CI = 1.1-4.7), and more frequent fast food consumption at home was associated with higher odds of overweight cross-sectionally (OR = 3.1, 95% CI = 1.4-7.0).

Conclusions. This study found few significant associations between aspects of the family food environment and BMI z-score or weight status in a sample of Australian children.

Children's takeaway and fast-food intakes: associations with the neighbourhood food intakes : associations with the neighbourhood food environment

Objective: The present study aimed to examine associations between availability of outlets where takeaway or fast food could be purchased and consumption of takeaway or fast food among children.

Design Cross-sectional: Parents completed a questionnaire regarding the frequency per week their child usually ate takeaway or fast foods. The availability of outlets where these foods could be purchased close to home and en route to school was determined with a Geographic Information System (presence of any outlets and density of outlets within 800 m from home and along the route to school, and distance from home to closest outlet).

Setting: Greater Melbourne and Geelong, Australia.

Subjects: Three hundred and fifty-three children aged 5–6 years and 463 children aged 10–12 years.

Results: Overall, 69·4 % of children consumed takeaway or fast foods once weekly or more often. Only one measure of availability of outlets close to home was associated with consumption; each additional outlet within 800 m was associated with 3 % lower odds of consuming takeaway or fast foods at least once weekly (OR = 0·97, 95 % CI 0·95, 1·00). There were no associations between availability en route to school and the likelihood of consuming takeaway or fast food at least once weekly.

Conclusions:  Access to outlets where takeaway or fast food could be purchased did not predict frequency of consumption of takeaway or fast food in the expected direction. Such relationships appear to be complex and may not be adequately captured by the measures of access included in the current study.

Where do entrepreneurs have the best chances of success? The Asia-Pacific regulatory environment for entrepreneurial Micro And Medium Sized Enterprises (MMES)

Why do some entrepreneurs succeed while others fail in international competition? Perhaps it is better to turn the question around and ask, why is it that a particular country or economy becomes the home base for competitive globally-oriented entrepreneurs? What makes Australia a global leader in wine exports? How did New Zealand make it to global ranks in the creative industries? Why does Singapore have the most businessfriendly environment for entrepreneurs? Why is it “location, location, location”? One of the most powerful factors is the regulatory environment.

Asia-Pacific country-specific and region-specific regulations are diverse, and they seriously affect the climate for start-up entrepreneurs. They range from best-in-the world (e.g. Australia, New Zealand and Singapore) to the dreadful (Indonesia), according to the World Bank. Costs and profits can be affected as much by a government regulation as by a management decision. Fundamental entrepreneurial decisions--such as which lines of business to go into, which products and services to produce and introduce, which investments to finance, how and where to make goods and how to market them, and what prices to charge--are increasingly subject to governmental control.

In this short paper, we examine World Bank and Transparency International data on Asia-Pacific regulatory environments and make statements about how the economies compare to best practice. While I use data collected by other sources, I believe the added value comes through comparing and contrast the regulatory environments of our region in a justifiable and easily understood manner.

Presbyterian ethos and environment in the novels of John Buchan : a religious and historical study

The aim of this thesis is to establish, from a historical and religious perspective, that the Presbyterian ethos and environment in which John Buchan was reared was the predominating influence in the writing of his novels. Presbyterianism was not the only influence on Buchan that determined the character of his stories. Buchan was by temperament a romantic, and this had considerable influence on his literature. His novels are romances, peopled by romantic figures who pursue romantic adventures. There are the signs of Buchan's romantic nature in the contents of the novels: creative imagination, sensitivity to nature, and expectations of the intrusion of other worlds, with destiny-determining events to follow. But Buchan had also an acquired classicism. His studies at Glasgow and Oxford Universities brought him in touch with a whole range of the master-pieces of classical literature, especially the works of Plato and Virgil. This discipline gave him clarity and conciseness in style, and balanced the romantic element in him, keeping his work within the bounds of reason. At the heart of Buchan's life and work, however, was his deeply religious nature and this, while influenced by romanticism and classicism, was the dominant force behind his work. Buchan did not accept in its entirety the Presbyterian doctrine conveyed to him by his father and his Church. He was moderate by temperament and shrank from excesses in religious matters, and, being a romantic, he shied away from any fixed creeds. He did embrace the fundamentals of Christianity, however, which he learned from his father and his Church, even if he did put aside the Rev. John's orthodox Calvinism. The basic Christianity which underlies all Buchan's novels has the stamp of Presbyterianism upon it, and that stamp is evident in his characters and their adventures. The expression of Christianity which Buchan embraced was the Christian Platonism of seventeenth century theologians, who taught and preached at Cambridge University, They gave prominence to the place of reason and conscience in man's search for God, They believed that reason and conscience were the ‘candle of the Lord’ which was existed every one. It was their conviction that, if that light was followed, it would lead men and women to God. They were against superstition and fanaticism in religion, against all forms of persecution for religious beliefs, and insisted that God could only be known by renouncing evil and setting oneself to live according to God’s will. This teaching Buchan received, but the stamp of his Presbyterianism was not obliterated. The basic doctrines which arose from his father's Presbyterianism and are to be found in Buchan's novels are as follows: a. the fear (or awe) of God, as life's basic religious attitude; b. the Providence of God as the ultimate determinative force in the outcome of events; c. the reality, malignity and universality of evil which must be forcefully and constantly resisted; d. the dignity of human beings in bearing God's image; e. the conviction that life has meaning and that its ultimate goal, therefore, is a spiritual one - as opposed to the accumulation of wealth, the achieving of recognition from society, and the gaining access to power; f. the necessity of challenge in life for growth and fulfilment, and the importance of fortitude in successfully meeting such challenge; g. the belief that, in the purpose of God, the weak confound the strong. These emphases of Presbyterianism are to be found in all Buchan's novels, to a greater or lesser degree. All his characters are serious people, with a moral purpose in life. Like the pilgrims of the Bible, they seek a country: true fulfilment. This quest becomes more spiritual and more dearly defined as Buchan grows in age and maturity. The progress is to be traced from his early novels, where fulfilment is sought in honour and self-approving competence, as advocated by classicism; to the novels of his middle years, where fulfilment is sought in adventures suggested by romanticism. In his final novel Sick Heart River. Buchan appears to have moved somewhat from his earlier classicism and his romanticism as the road to fulfilment. In this novel, Buchan expresses what, for him, is ultimate fulfilment: a conversion to God that produces self-sacrificing love for others. The terminally-ill Edward Leithen sets out on a romantic adventure that will enable him to die with dignity, and so, in classic style, justify his existence. He has a belief in God, but in a God who is almighty, distant and largely irrelevant to Leithen's life. In the frozen North of Canada, where he expects to find his meagre beliefs in God's absolute power confirmed by the icy majesty of mountain and plain, he finds instead God's mercy and it melts his heart. In a Christ-like way, he brings life to others through his death, believing that, through death, he will find life. There is sufficient evidence to give plausibility to the view that Buchan is describing in Leithen his own pilgrimage. If so, it means that Buchan found his way back to the fundamental experience of the Christian life, conversion, so strongly emphasised in his orthodox Presbyterianism home and Church. However, Buchan reaches this conclusion in a Christian Platonist way, through the natural world, rather than through the more orthodox pathway of Scripture.

The influence of the environment on children's physical activity

Qualitative and quantitative methodologies were used to examine the influence of physical and social environments at home and in the neighbourhood, on 10-year-old children's walking and physical activity. Findings suggest that environmental factors can attenuate declines in walking and physical activity over a 16-month period.

House, home and dwellings - in an Australian context

Theoretical evidence in the behavioural and social sciences has shown the home to be a phenomenon borne of the complex relationship between individuals and their environment. A qualitative assessment of the specific home experiences of 12 case studies is offered to establish an understanding of home within a particular socio-cultural context in Australia. The thesis contends that the affective home has primacy in the home experience.