A snapshot of Australian nurse practitioners’ extended practice activities

Introduction The Australian Nurse Practitioner Project (AUSPRAC) was initiated to examine the introduction of nurse practitioners into the Australian health service environment. The nurse practitioner concept was introduced to Australia over two decades ago and has been evolving since. Today, however, the scope of practice, role and educational preparation of nurse practitioners is well defined (Gardner et al, 2006). Amendments to specific pre-existing legislation at a State level have permitted nurse practitioners to perform additional activities including some once in the domain of the medical profession. In the Australian Capital Territory, for example 13 diverse Acts and Regulations required amendments and three new Acts were established (ACT Health, 2006). Nurse practitioners are now legally authorized to diagnose, treat, refer and prescribe medications in all Australian states and territories. These extended practices differentiate nurse practitioners from other advanced practice roles in nursing (Gardner, Chang & Duffield, 2007). There are, however, obstacles for nurse practitioners wishing to use these extended practices. Restrictive access to Medicare funding via the Medicare Benefit Scheme (MBS) and the Pharmaceutical Benefit Scheme (PBS) limit the scope of nurse practitioner service in the private health sector and community settings. A recent survey of Australian nurse practitioners (n=202) found that two-thirds of respondents (66%) stated that lack of legislative support limited their practice. Specifically, 78% stated that lack of a Medicare provider number was ‘extremely limiting’ to their practice and 71% stated that no access to the PBS was ‘extremely limiting’ to their practice (Gardner et al, in press). Changes to Commonwealth legislation is needed to enable nurse practitioners to prescribe medication so that patients have access to PBS subsidies where they exist; currently patients with scripts which originated from nurse practitioners must pay in full for these prescriptions filled outside public hospitals. This report presents findings from a sub-study of Phase Two of AUSPRAC. Phase Two was designed to enable investigation of the process and activities of nurse practitioner service. Process measurements of nurse practitioner services are valuable to healthcare organisations and service providers (Middleton, 2007). Processes of practice can be evaluated through clinical audit, however as Middleton cautions, no direct relationship between these processes and patient outcomes can be assumed.

Green roofs : understanding their benefits for Australia

Summary of Actions Towards Sustainable Outcomes Environmental Issues / Principal Impacts The increased growth of cities is intensifying its impact on people and the environment through: • increased use of energy for the heating and cooling of more buildings, leading to urban heat islands and more greenhouse gas emissions • increased amount of hard surfaces contributing to higher temperatures in cities and more stormwater runoff • degraded air quality and noise impact • reduced urban biodiversity • compromised health and general well-being of people Basic Strategies In many design situations boundaries and constraints limit the application of cutting EDGe actions. In these circumstances designers should at least consider the following: • Consider green roofs early in the design process in consultation with all stakeholders to enable maximised integration with building systems and to mitigate building cost (avoid constructing as a retrofit). • Design of the green roof as part of a building’s structural, mechanical and hydraulic systems could lead to structural efficiency, the ability to optimise cooling benefits and better integrated water recycling systems. • Inform the selection of the type of green roof by considering its function, for example designing for social activity, required maintenance/access regime, recycling of water or habitat regeneration or a combination of uses. • Evaluate existing surroundings to determine possible links to the natural environment and choice of vegetation for the green roof with availability of local plant supply and expertise. Cutting EDGe Strategies • Create green roofs to contribute positively to the environment through reduced urban heat island effect and building temperatures, to improved stormwater quality, increased natural habitats, provision of social spaces and opportunity for increased local food supply. • Maximise solar panel efficiency by incorporating with design of green roof. • Integrate multiple functions for a single green roof such as grey water recycling, food production, more bio-diverse plantings, air quality improvement and provision of delightful spaces for social interaction. Synergies & references • BEDP Environment Design Guide DES 53: Roof and Facade Gardens GEN 4: Positive Development – designing for Net Positive Impacts TEC 26: Living Walls - a way to green the built environment • Green Roofs Australia: www.greenroofs.wordpress.com • International Green Roof Association: www.igra-world.com • Green Roofs for Healthy Cities (USA): www.greenroofs.org • Centre for Urban Greenery and Ecology (Singapore): http://research.cuge.com.sg

The centrality of teachers’ judgement practice in assessment : a study of standards in moderation

There is a strong quest in several countries including Australia for greater national consistency in education and intensifying interest in standards for reporting. Given this, it is important to make explicit the intended and unintended consequences of assessment reform strategies and the pressures to pervert and conform. In a policy context that values standardisation, the great danger is that the technical, rationalist approaches that generalise and make superficial assessment practices, will emerge. In this article, the authors contend that the centrality and complexity of teacher judgement practice in such a policy context need to be understood. To this end, we discuss and analyse recorded talk in teacher moderation meetings showing the processes that teachers use as they work with stated standards to award grades (A to E). We show how they move to and fro between (1) supplied textual artefacts, including stated standards and samples of student responses, (2) tacit knowledge of different types, drawing into the moderation, and (3) social processes of dialogue and negotiation. While the stated standards play a part in judgement processes, in and of themselves they are shown to be insufficient to account for how the teachers ascribe value and award a grade to student work in moderation. At issue is the nature of judgement as cognitive and social practice in moderation and the legitimacy (or otherwise) of the mix of factors that shape how judgement occurs.

Mapping social enterprise in Australia : conceptual debates and their operational implications

In the last ten years, there has been growing interest in social enterprise by governments, the not for profit sector and philanthropy in Australia The drivers of this interest have been variously understood to be: increasing demands for innovative responses to social and environmental problems; pressures on non-profit organisations to diversify their income sources; and increasing emphases by government on the role of civil society actors in partnering around social policy agendas. Whatever its genesis, very little is known about the scale and scope of the emerging social enterprise sector. In order to research the scope of the sector, an important first step involves understanding just what social enterprise is, and how it may be operationalised. This paper presents the findings from the first stage of a national research project conducted by the authors in conjunction with a new social enterprise development company. The purpose of the project was to provide a comprehensive snapshot of the social enterprise sector in Australia. In this paper, we focus on the definitional debates arising from our workshop discussions, what these mean for understanding contemporary discourses of social enterprise, and their implications for research, policy and practice.

The role of organisational capacity in the knowledge-based transformation of Brisbane, Australia

Purpose - The cumulative impacts of the knowledge economy together with the emerging dominance of knowledge-intensive sectors, have led to an unprecedented period of socio-economic and spatial restructuring. As a result, the paradigm of knowledge-based urban development (KBUD) has emerged as a development strategy to guide knowledge-based economic transformation (Knight, 1995; Yigitcanlar, 2007). Notwithstanding widespread government commitment and financial investment, in many cases providing the enabling circumstances for KUBUD has proven a complicated task as institutional barriers remain. Researchers and practitioners advocate that the way organisations work and their institutional relationships, policies and programs, will have a significant impact on a regions capacity to achieve KBUD (Savitch, 1998; Savitch and Kantor, 2002; Keast and Mandell, 2009). In this context, building organisational capacity is critical to achieving institutional change and bring together all of the key actors and sources, for the successful development, adoption, and implementation of knowledge-based development of a city (Yigitcanlar, 2009). Design/methodology/approach - There is a growing need to determine the complex inter-institutional arrangements and intra-organisational interactions required to advance urban development within the knowledge economy. In order to design organisational capacity-building strategies, the associated attributes of good capacity must first be identified. The paper, with its appraisal of knowledge-based urban development, scrutinises organisational capacity and institutional change in Brisbane. As part of the discussion of the case study findings, the paper describes the institutional relationships, policies, programs and funding streams, which are supporting KBUD in the region. Originality/value - In consideration that there has been limited investigation into the institutional lineaments required to provide the enabling circumstances for KBUD, the broad aim of this paper is to discover some good organisational capacity attributes, achieved through a case study of Brisbane. Practical implications - It is anticipated that the findings of the case study will contribute to moving the discussion on the complex inter-institutional arrangements and intra-organisaational interactions required for KBUD, beyond a position of rhetoric.

Colin Marsh (2008) Becoming a Teacher: Knowledge, Skills and Issues. 4th edition, Frenchs Forrest: Pearson Education Australia, 460 pages

Becoming a Teacher is structured in five very readable sections. The introductory section addresses the nature of teaching and the importance of developing a sense of purpose for teaching in a 21st century classroom. It also introduces some key concepts that are explored throughout the volume according to the particular chapter focus of each part. For example, the chapters in Part 2 explore aspects of student learning and the learning environment and focus on how students develop and learn, learner motivation, developing self esteem and learning environments. The concepts developed in this section, such as human development, stages of learning, motivation, and self-concept are contextualised in terms of theories of cognitive development and theories of social, emotional and moral development. The author, Colin Marsh, draws on his extensive experience as an educator to structure the narrative of chapters in this part via checklists for observation, summary tables, sample strategies for teaching at specific stages of student development, and questions under the heading ‘your turn’. Case studies such as ‘How I use Piaget in my teaching’ make that essential link between theory and practice, something which pre-service teachers struggle with in the early phases of their university course. I was pleased to see that Marsh also explores the contentious and debated aspects of these theoretical frameworks to demonstrate that pre-service teachers must engage with and critique the ways in which theories about teaching and learning are applied. Marsh weaves in key quotations and important references into each chapter’s narrative and concludes every chapter with summary comments, reflection activities, lists of important references and useful web sources. As one would expect of a book published in 2008, Becoming a Teacher is informed by the most recent reports of classroom practice, current policy initiatives and research.

Trends in impaired driving in Australia in 2010 : a status report

This paper reviews the status of alcohol, drugs and traffic safety in Australia, with particular emphasis on developments in the period 2008-2010. Australian jurisdictions have made impressive improvements in road safety since the early 1970s. Enforcement and public education campaigns that specifically target drink driving have been successful, with resultant long-term reduction in alcohol-related fatalities. There is a high level of community disapproval of drink driving and strong support for countermeasures. Many best-practice countermeasures targeting impaired driving are in place, including general prevention/ deterrence programs such as random breath testing (RBT), random roadside drug testing legal alcohol limits, responsible service of alcohol programs, public education and advertising campaigns and designated driver programs, and offender management programs such as driver licensing penalties and fines, alcohol ignition interlocks and vehicle impoundment for high risk drink drivers, and offender education programs. There continue to be enhancements occurring, particularly in the areas of drug-impaired driving and offender management, but also in addressing the fundamental policy and legislative framework to address impaired driving (e.g., a current national debate about lowering the permissible blood alcohol for all drivers from 0.05 to 0.02 or 0.00 gm/100 ml BAC). However, there are major challenges that may be impacting on programs targeting impaired driving, including the rapid development of a binge drinking culture among young Australians, the extension of trading hours of licensed premises, continued problems with secondary supply of alcohol to minors, and increases in the marketing of alcopops and ready-to-drink spirit-based beverages. This paper addresses the question: Are impaired driving countermeasures in Australia continuing to achieve reductions in road traumas and rates of offending, or are they plateauing? If they are plateauing, is this due to declining effectiveness of countermeasures or the need to ‘hold the line’ against societal influences encouraging impaired driving?

Xiamen Hai Cang tourism project : landscape planning and design of five islands

International practice-led design research in landscape architecture has identified the need for addressing the loss of biodiversity in urban environments. China has lost much of its biodiversity in rural and urban environments over thousands of years. However some Chinese cities have attempted to conserve what remains and enhance existing vegetation communities in isolated pockets. Island biogeography has been used as the basis for planning and designing landscapes in Australia and North America but not as yet in China, as far as we know. A gap in landscape design knowledge exists regarding how to apply landscape ecology concepts to urban islands of remaining biodiversity being developed for heavy Chinese domestic tourism impacts in the future. This project responded to the demands for harbour-side tourism opportunities in Xiamen City, Fujian Province, by proposing a range of eco-design innovations using concepts of patch, edge and interior to interconnect people and nature in a Chinese setting.

The impact of changes to the graduated driver licensing program in Queensland, Australia on the experiences of learner drivers

Purpose: Graduated driver licensing (GDL) has been introduced in numerous jurisdictions in Australia and internationally in an attempt to ameliorate the significantly greater risk of death and injury for young novice drivers arising from road crashes. The GDL program in Queensland, Australia, was extensively modified in July 2007. This paper reports the driving and licensing experiences of Learner drivers progressing through the current-GDL program, and compares them to the experiences of Learners who progressed through the former-GDL program. ----- ----- Method: Young drivers (n = 1032, 609 females, 423 males) aged 17 to 19 years (M = 17.43, SD = 0.67) were recruited as they progressed from a Learner to a Provisional driver’s licence. They completed a survey exploring their sociodemographic characteristics, driving and licensing experiences as a Learner. Key measures for a subsample (n = 183) of the current-GDL drivers were compared with the former-GDL drivers (n = 149) via t-tests and chi-square analyses. ----- ----- Results: As expected, Learner drivers progressing through the current-GDL program gained significantly more driving practice than those in the former program, which was more likely to be provided by mothers than in the past. Female learners in the current-GDL program reported less difficulty obtaining supervision than those in the former program. The number of attempts needed to pass the practical driving assessment did not change, nor did the amount of professional supervision. The current-GDL Learners held their licence for a significantly longer duration than those in the former program, with the majority reporting that their Logbook entries were accurate on the whole. Compared to those in the former program, a significantly smaller proportion of male current-GDL Learners reported being detected for a driving offence while the females reported significantly lower crash involvement. Most current-GDL drivers reported undertaking their supervised practice at the end of the Learner period. ----- ----- Conclusions: The enhancements to the GDL program in Queensland appear to have achieved many of their intended results. The current-GDL learners participating in the study reported obtaining a significantly greater amount of supervised driving experience compared to former-GDL learners. Encouragingly, the current-GDL Learners did not report any greater difficulty in obtaining supervised driving practice, and there was a decline in the proportion of current-GDL Learners engaging in unsupervised driving. In addition, the majority of Learners do not appear to be attempting to subvert logbook recording requirements, as evidenced by high rates of self-reported logbook accuracy. The results have implications for the development and the evaluation of GDL programs in Australia and around the world.

Changing academic practice to prepare nursing undergraduates for an evidence-based approach

Evidence based practice (EBP) has been accepted as a process to assist health professionals in clinical decision making to improve patient outcomes. It requires applying skills in a prescribed sequence to critique existing practices. Many countries, including Australia, require nurses to demonstrate competencies in EBP skills to be registered. In the last ten years, this has lead to universities incorporating EBP in undergraduate nursing degree courses. The literature reports many challenges including students’ difficulties in critically appraising research evidence, and their need for both simplification of the process and extensive support. The purpose of our study was to investigate the effectiveness of a standalone introductory EBP subject for a diverse group of third-year undergraduates, based on a novel but challenging approach to assessment. Despite many changes made in the second iteration of the subject, most students’ perceptions of the subject’s difficulty remained unchanged. This research aligns with the issues identified in the literature and has wider applicability to the teaching of rapidly changing disciplines, where evidence-driven consumers have easy access to information and expect up-to-date practices.

Construction 2020 - A vision for Australia's Property and Construction Industry

Construction 2020 is a national initiative undertaken by CRC for Construction Innovation to focus its ongoing leadership of the Australian property and construction industry in applied research and best contribute to the industry's national and international growth and competitiveness. It is the first major report on the long-term outlook for the industry since the late 1990s. The report identifies nine key themes for the future of the property and construction industry. These visions describe the major concerns of the industry and the improved future working environment favoured by its stakeholders. The first and clearest vision, agreed across the industry, is that environmentally sustainable construction the creation of buildings and infrastructure that minimise their impact on the natural environment is an area of huge potential. Here technologies like Construction Innovation's LCADesign can make a big difference. This is a calculator that works out automatically from 3D computer-aided design the environmental costs of materials in a building all at the push of a button. By working with industry, we'd expect to have a comprehensive set of eco-design tools for all stages of the construction life cycle, to minimise energy use, greenhouse and other forms of waste or pollution. Other significant areas of focus in the report include the development of nationally uniform codes of practice, new tools to evaluate design and product performance, comparisons with overseas industries, and a worldwide research network to ensure that Australian technology is at the cutting edge.

Bushfire sustainability : Strategies for reconciling bushfire and biodiversity with daily life

This exhibition and catalogue provides a visual record of student work exhibited at the Australian Institute of Architects offices in Brisbane from November 15 to 29, 2010. The exhibition features the final design outcomes of the inaugural Bushfire Sustainability unit conducted at QUT in semester two, 2010. The core objective of this unit was to develop our students’ skills in collaborative practice in design, research and presentation. The theme of ‘bushfire sustainability’ was chosen because living sustainably in bushfire prone landscapes presents a number of problems, the nature of which might only be resolved via multidisciplinary collaboration among the design disciplines. The students involved represent the disciplines of Interior Design, Landscape Architecture, Industrial Design, Architecture and Sustainability – all from within the School of Design at QUT. 55 students, mostly in their third year of study, worked in teams of five (one from each discipline) to design one of a number of homes in highly bushfire prone sites in either Western Australia or SE Queensland. This year level and the interdisciplinary mix are perhaps the best placed to resolve these problems: being unrestrained from the burdens of professional practice and technical overload they retain the potential for innovative, lateral thinking across the range of spatial scales and philosophical perspectives associated with inhabitation of bushfire prone landscapes. It is envisaged that, through the ‘vehicle’ of this design research, that the students’ work will contribute to understandings of how creative design disciplines might respond to this significant national problem, which hitherto has been attended to primarily by engineering and the sciences.

Project alliancing at National Museum of Australia : the collaborative process

Project alliancing is a new alternative to traditional project delivery systems, especially in the commercial building sector. The Collaborative Process is a theoretical model of people and systems characteristics that are required to reduce the adversarial nature of most construction projects. Although developed separately, both are responses to the same pressures. Project alliancing was just used successfully to complete the National Museum of Australia. This project was analyzed as a case study to determine the extent to which it could be classified as a “collaborative project”. Five key elements of The Collaborative Process were reviewed and numerous examples from the management of this project were cited that support the theoretical recommendations of this model. In the case of this project, significant added value was delivered to the client and many innovations resulted from the collective work of the parties to the contract. It was concluded that project alliances for commercial buildings offer many advantages over traditional project delivery systems, which are related to increasing the levels of collaboration among a project management team.

Assessment for learning in the accountability era : Queensland, Australia

Developments in school education in Australia over the past decade have witnessed the rise of national efforts to reform curriculum, assessment and reporting. Constitutionally the power to decide on curriculum matters still resides with the States. Higher stakes in assessment, brought about by national testing and international comparative analyses of student achievement data, have challenged State efforts to maintain the emphasis on assessment to promote learning while fulfilling accountability demands. In this article lessons from the Queensland experience indicate that it is important to build teachers' assessment capacity and their assessment literacy for the promotion of student learning. It is argued that teacher assessment can be a source of dependable results through moderation practice. The Queensland Studies Authority has recognised and supported the development of teacher assessment and moderation practice in the context of standards-driven, national reform. Recent research findings explain how the focus on learning can be maintained by avoiding an over-interpretation of test results in terms of innate ability and limitations and by encouraging teachers to adopt more tailored diagnosis of assessment data to address equity through focus on achievement for all. Such efforts are challenged as political pressures related to the Australian government’s implementation of national testing and national partnership funding arrangements tied to the performance of students at or below minimum standards become increasingly apparent.

Socially adaptable housing new housing model for families living with disability

In Australia as far back as 1993, researchers such as Baladin and Chapmen reported that "18% of the total Australian population and 51% of the population over 60 years of age were identified as having a disability" (2001; p38.2). Statistics such as these are not by any means astonishing, even to members of the general public, and it is widely understood that these are only to increase significantly in our near future. What is particularly surprising however is, in the face of such statistics, the lack of new and creative responses to this demographic shift, particularly by the architecture and construction industries. The common response from a range of sectors seems to be the repetition of a series of models which offer limited, and often undesirable, housing options. It is this against this backdrop, characterized by a lack of original options from mainstream practitioners and relevant government bodies, that the need has arisen to develop alternative models at grass-roots level. This paper reports primarily on the work of one group comprising a not-for-profit organization, a pro-bono design practice group and a local university working together to design a more holistic, emotionally sustainable independent living model of housing for families where a member of the family has a disability. This approach recognizes the limitations of universal design in that it often does not " ... meet all the housing needs that arise for people with moderate to severe disabilities" (Scotts, Margie et al, 2007; p.17). It is hoped that by examining the work of such a collective which is not driven by profit or policy, but rather born with the aim to address first and foremost individual and community need, that better insight can be gained into the real requirements of individuals and families as well as open up a view to new ways of fulfilling them.