Nursing casualisation and communication : a critical ethnography

Aim The aim was to explore the relationship between nursing casualization and the culture of communication for nurses in a healthcare facility. Background Casualization, or non-standard work, is the use of temporary, contract, part-time and casual labour. An increase in casual labour has been part of a global shift in work organization aimed at creating a more flexible and cheaper workforce. It has been argued that flexibility of labour has enabled nurses to manage both non-work related needs and an increasingly complex work environment. Yet no research has explored casualization and how it impacts on the communication culture for nurses in a healthcare facility. Design Critical ethnography. Methods Methods included observation, field notes, formal interviews and focus groups. Data collection was undertaken over the 2 years 2008–2009. Results The concepts of knowing and belonging were perceived as important to nursing teamwork and yet the traditional time/task work model, designed for a full-time workforce, marginalized non-standard workers. The combination of medical dominance and traditional stereotyping of the nurse and work as full-time shaped the behaviours of nurses and situated casual workers on the periphery. The overall finding was that entrenched systemic structures and processes shaped the physical and cultural dimensions of a contemporary work environment and contributed to an ineffective communication culture. Conclusion Flexible work is an important feature of contemporary nursing. Traditional work models and nurse attitudes and practices have not progressed and are discordant with a contemporary approach to nursing labour management.

Improving safety communication of ethnic minorities in the construction industry of Hong Kong

The construction workforce in Hong Kong is experiencing a severe ageing problem and labour shortage. One initiative to enhance the supply of manpower is to assist ethnic minorities joining the industry. It is foreseeable that the percentage of ethnic minorities in the construction workforce will keep increasing. Statistics show that ethnic minorities were nearly 30% more likely to have work-related injuries than local workers in some developed countries. However, official statistics on the safety of ethnic minorities are not available in Hong Kong. A search in newspaper archive revealed that ethnic minorities in the construction industry of Hong Kong are subjected to higher fatality rate than local workers, just as is the case in many developed countries. This reflects that the safety of ethnic minorities has not received the attention it rightly deserves. Safety communication has been one of the key factors leading to accidents. Safety communication barriers of ethnic minorities impede them from receiving safety training and acquiring safety information effectively. Research towards improving the safety communication of ethnic minorities in the construction industry of Hong Kong becomes more urgent. This paper will provides an initial report on a research project which focuses on improving the safety communication of ethnic minorities in the construction industry of Hong Kong. Quantitative and qualitative research methods including Social Network Analysis (SNA) applied in conducting the research are first discussed. Preliminary statistics of construction accidents related to ethnic minorities in Hong Kong are then presented.

The challenge of developing a fleet driving risk assessment tool: What can be learned from the process?

One of the riskiest activities in the course of a person's work is driving. By developing and testing a new work driving risk assessment measurement tool for use by organisations this research will contribute to the safety of those who drive for work purposes. The research results highlighted limitations associated with current self-report measures and provided evidence that the work driving environment is extremely complex and involves constant interactions between humans, vehicles, the road environment, and the organisational context.

Reflections and encounters: Exploring awareness in an academic environment

Earlier work within the CSCW community treated the notion of awareness as an important resource for supporting shared work and work-related activities. However, new trends have emerged in recent times that utilize the notion of awareness beyond work-related activities and explore social, emotional and interpersonal aspects of people’s everyday lives. To investigate this broader notion of awareness, we carried out a field study using ethnographic and cultural probe based methods in an academic setting. Our aim was to study staff members’ everyday activities in their natural surroundings; understand how awareness beyond work-related activities plays out and how it is dealt with. Our field study results shed light on two broad and sometimes overlapping themes of interaction between staff members: 1) self-representations and 2) casual encounters. We provide examples from the field illustrating these two themes. In general, our results show how awareness is closely associated with people’s everyday lives, where they creatively and artfully utilize ordinary resources from their environments to carry out their routine activities. Using the results of our field study, we describe the design of a situated display called Panorama that is meant to support non-critical, non-work-related awareness within work environments.

Eating for health and the environment: Australian regulatory responses for dietary change

The Australian food system significantly contributes to a range of key environmental issues including harmful greenhouse gas emissions, air pollution, soil desertification, biodiversity loss and water scarcity. At the same time, the Australian s food system is a key cause of public health nutrition issues that stem from the co-existence of over- and under-consumption of dietary energy and nutrients. Within these challenges lie synergies and opportunities because a diet that has a lower environmental impact generally aligns with good nutrition. Australian State and Federal initiatives to influence food consumption patterns focus on individual body weight and ‘soft law’ interventions. These regulatory approaches, by focusing on select symptoms of food system failures, are fragmented, reductionist and inefficient. In order to illustrate this point, this paper will explore Australian regulatory responses to diet-related illnesses. The analysis will support the argument that only when regulatory responses to diets become embedded within reform of the current food system will substantial improvements to human and planetary health be achieved.

The effects of prediction, understanding, and control: A test of the stress antidote model

A study was undertaken to examine further the effects of perceived work control on employee adjustment. On the basis of the stress antidote model, it was proposed that high levels of prediction, understanding, and control of work-related events would have direct, indirect, and interactive effects on levels of employee adjustment. These hypotheses were tested in a short-term longitudinal study of 137 employees of a large retail organization. The stress antidote measures appeared to be indirectly related to employee adjustment, via their effects on perceptions of work stress. There was weak evidence for the proposal that prediction, understanding, and control would buffer the negative effects of work stress. Additional analyses indicated that the observed effects of prediction, understanding, and control were independent of employees' generalized control beliefs. However, there was no support for the proposal that the effects of the stress antidote measures would be dependent on employees' generalized control beliefs.

Super DNAging - New insights into DNA integrity, genome stability and telomeres in the oldest old

Reductions in DNA integrity, genome stability, and telomere length are strongly associated with the aging process, age-related diseases as well as the age-related loss of muscle mass. However, in people reaching an age far beyond their statistical life expectancy the prevalence of diseases, such as cancer, cardiovascular disease, diabetes or dementia, is much lower compared to “averagely” aged humans. These inverse observations in nonagenarians (90–99 years), centenarians (100–109 years) and super-centenarians (110 years and older) require a closer look into dynamics underlying DNA damage within the oldest old of our society. Available data indicate improved DNA repair and antioxidant defense mechanisms in “super old” humans, which are comparable with much younger cohorts. Partly as a result of these enhanced endogenous repair and protective mechanisms, the oldest old humans appear to cope better with risk factors for DNA damage over their lifetime compared to subjects whose lifespan coincides with the statistical life expectancy. This model is supported by study results demonstrating superior chromosomal stability, telomere dynamics and DNA integrity in “successful agers”. There is also compelling evidence suggesting that life-style related factors including regular physical activity, a well-balanced diet and minimized psycho-social stress can reduce DNA damage and improve chromosomal stability. The most conclusive picture that emerges from reviewing the literature is that reaching “super old” age appears to be primarily determined by hereditary/genetic factors, while a healthy lifestyle additionally contributes to achieving the individual maximum lifespan in humans. More research is required in this rapidly growing population of super old people. In particular, there is need for more comprehensive investigations including short- and long-term lifestyle interventions as well as investigations focusing on the mechanisms causing DNA damage, mutations, and telomere shortening.

Genetics and the pathogenesis of ankylosing spondylitis

Purpose of review The field of genetic research in ankylosing spondylitis (AS) is advancing rapidly. The purpose of this review is to outline recent findings, particularly, in regard to genetic studies of the major histocompatibility complex (MHC) and the non-MHC genes IL23R, ERAP1, and killer cell immunologlobulin-like receptor (KIR) complex, in AS. Recent findings: Convincing evidence has been reported for the existence of further non-B27 MHC genes involved in AS. Strong, replicated association has been reported with IL23R and ERAP1 and AS. The IL23R finding strongly implicates the TH17 lymphocyte system in AS aetiopathogenesis. Suggestive evidence of a role for KIR gene polymorphism in AS exists, but definitive findings are awaited. Summary: The findings suggest that further genome-wide studies in large case-control cohorts are likely to be very productive in this disease. The IL23R findings and subsequent immunological investigations suggest that targeted intervention in the TH17 system is likely to have major therapeutic benefit, as it does in the genetically related diseases, inflammatory bowel disease and psoriasis.

Genetics of ankylosing spondylitis

Purpose of Review Over the past 3 years, several new genes and gene deserts have been identified that are associated with ankylosing spondylitis (AS). The purpose of this review is to discuss the major findings of these studies, and the answers they provide and questions they raise about the pathogenesis of this common condition. Recent Findings: Five genes/genetic regions have now definitively been associated with AS [the major histocompatibility complex (MHC), IL23R, ERAP1, 2p15 and 21q22]. Strong evidence to support association with the disease has been demonstrated for the genes IL1R2, ANTXR2, TNFSF15, TNFR1 and a region on chromosome 16q including the gene TRADD. There is an overrepresentation of genes involved in Th17 lymphocyte differentiation/activation among genes associated with AS and the related diseases inflammatory bowel disease and psoriasis, pointing strongly to this pathway as playing a major causative role in the disease. Increasing information about differential association of HLA-B27 subtypes with disease suggests a hierarchy of strength of association of those alleles with AS, providing a useful test as to the validity of different potential mechanisms of association of HLA-B27 with AS. The mechanism underlying the association of the gene deserts, 2p15 and 21q22, suggests the involvement of noncoding RNA in AS etiopathogenesis. Summary: The increasing list of genes identified as being definitely involved in AS provides a useful platform for hypothesis-driven research in the field, providing a potential alternative route to determining the underlying mechanisms involved in the disease to research focusing on HLA-B27 alone.

Identification of IL6R and chromosome 11q13.5 as risk loci for asthma

We aimed to identify novel genetic variants affecting asthma risk, since these might provide novel insights into molecular mechanisms underlying the disease. We did a genome-wide association study (GWAS) in 2669 physician-diagnosed asthmatics and 4528 controls from Australia. Seven loci were prioritised for replication after combining our results with those from the GABRIEL consortium (n=26 475), and these were tested in an additional 25 358 independent samples from four in-silico cohorts. Quantitative multi-marker scores of genetic load were constructed on the basis of results from the GABRIEL study and tested for association with asthma in our Australian GWAS dataset. Two loci were confirmed to associate with asthma risk in the replication cohorts and reached genome-wide significance in the combined analysis of all available studies (n=57 800): rs4129267 (OR 1·09, combined p= 2·4×10-8) in the interleukin-6 receptor (IL6R) gene and rs7130588 (OR 1·09, p=1·8×10-8) on chromosome 11q13.5 near the leucine-rich repeat containing 32 gene (LRRC32, also known as GARP). The 11q13.5 locus was significantly associated with atopic status among asthmatics (OR 1·33, p=7×10-4), suggesting that it is a risk factor for allergic but not non-allergic asthma. Multi-marker association results are consistent with a highly polygenic contribution to asthma risk, including loci with weak effects that might be shared with other immune-related diseases, such as NDFIP1, HLA-B, LPP, and BACH2. The IL6R association further supports the hypothesis that cytokine signalling dysregulation affects asthma risk, and raises the possibility that an IL6R antagonist (tocilizumab) may be effective to treat the disease, perhaps in a genotype-dependent manner. Results for the 11q13.5 locus suggest that it directly increases the risk of allergic sensitisation which, in turn, increases the risk of subsequent development of asthma. Larger or more functionally focused studies are needed to characterise the many loci with modest effects that remain to be identified for asthma. National Health and Medical Research Council of Australia. A full list of funding sources is provided in the webappendix. © 2011 Elsevier Ltd.

Organisational driving safety systems analysis: Fleet safety situational issues and system gaps

The identification of safety hazards and risks and their associated control measures provides the foundation for any safety program and essentially determines the scope, content and complexity of an effective occupational health and safety management system. In the case of work-related road safety (WRRS), there is a gap within current knowledge, research and practice regarding the holistic assessment of WRRS safety systems and practice. In order to mitigate this gap, a multi-level process tool for assessing WRRS safety systems was developed from extensive consultation, practice and informed by theoretical models and frameworks. Data collection for the Organisational Driving Safety Systems Analysis (ODSSA) tool utilised a case study methodology and included multiple information sources: such as documents, archival records, interviews, direct observations, participant observations, and physical artefacts. Previous trials and application of the ODSSA has indicated that the tool is applicable to a wide range of organisational fleet environments and settings. This paper reports on the research results and effectiveness of the ODSSA tool to assess WRRS systems across a large organisation that recently underwent considerable organisational change, including amalgamation of multiple organisations. The outcomes of this project identified considerable differences in the degree by which the organisation addressed WRRS across their vehicle fleet operations and provided guidelines for improving organisations’ WRRS systems. The ODSSA tool was pivotal in determining WRRS system deficiencies and provided a platform to inform mitigation and improvement strategies.

The National Road Safety Partnership Program providing a pathway for any business/organisation to create a positive road safety culture

The National Road Safety Partnership Program (NRSPP) is an industry-led collaborative network which aims to support Australian businesses in developing a positive road safety culture. It aims to help businesses to protect their employees and the public, not only during work hours, but also when their staff are ‘off-duty’. How do we engage and help an organisation minimise work-related vehicle crashes and their consequences both internally, and within the broader community? The first step is helping an organisation to understand the true cost of its road incidents. Larger organisations often wear the costs without knowing the true impact to their bottom line. All they perceive is the change in insurance or vehicle repairs. Understanding the true cost should help mobilise a business’s leadership to do more. The next step is ensuring the business undertakes an informed, structured, evidence-based pathway which will guide them around the costly pitfalls. A pathway based around the safe system approach with buy-in at the top which brings the workforce along. The final step, benchmarking, allows the organisation to measure and track its change. This symposium will explore the pathway steps for organisations using NRSPP resources to become engaged in road safety. The 'Total Cost of Risk' calculator has been developed by Zurich, tested in Europe by Nestle and modified by NRSPP for Australia. This provides the first crucial step. The next step is a structured approach through the Workplace Road Safety Guide using experts and industry to discuss the preferred safe system approach which can then link into the national Benchmarking Project. The outputs from the symposium can help frame a pathway for organisations to follow through the NRSPP website.

Podiatry scope of practice: The role of gender in identification as a specialist

Background Ensuring efficient and effective delivery of health care to an aging population has been a major driver for a review of the health workforce in Australia. As part of this review a new National Registration and Accreditation Scheme (NRAS) has evolved with one goal being to improve workforce flexibility. With increased flexibility there have been discussions about the role specialist scopes of practice plays. This study explored the role of gender and other work related characteristics in relation to contemporary scope of podiatry practice and specialisation in Australia. Methods A cross sectional survey was administered through an on-line survey tool on behalf of the Australasian Podiatry Council. Descriptive data was collected over a three-week period. Queensland University of Technology Human Research Ethics approval was sought and confirmed exemption from review, exemption number 1400000791. Results Of the podiatrists participating in this survey (n=218), they were predominately female (66%), early career (34%, 0-9 years) and work in private practices (78%) in multi-podiatrists centres (41%). Relationship between clinical activities performed and “self-perception” of performing a “specialist role” was significant for practitioners who undertook treatment of specific patient groups. The largest area of interest was biomechanics (n=65), followed closely by diabetes (n=61), a third area identified was paediatrics (n=26). Self-perception of specialist status was compared with gender, years of experience, location, primary work environment and clinical practice. When practitioners are asked to categorise themselves to be either “generalist” or “specialist/ generalist with a special interest” podiatrist, male gender was identified as being the only factor which would predict perception of status; 64% males identified as specialist, as opposed to 49% of female survey respondents (Chi square, df = 1, P = 0.044). Self-perception of specialist status was not explained by years of experience, location, working in rural versus urban environment, state worked in, or part-time/full-time work status. Conclusions In conclusion; gender, work environment plus area of interest form a complex relationship, which appear to influence both perception and reality of service provision. Incorporation of specialisation activity (surgical podiatry along with endorsement for use of scheduled medicines) will have lasting impact on the scope of the podiatry profession in Australia. To meet community expectation and maintain high standards, the addition of new subspecialties may be indicated.

Improving health and safety communication of migrant construction workers

Although statistical data in some developed countries indicate that migrant workers are nearly 30% more likely to have work-related injuries than local workers, no equivalent official injury/ incident statistics on the health and safety (H&S) of migrant workers are currently tracked in Australia. With increasing numbers of migrant workers having joined Australia’s extractive industries infrastructure and commercial construction industry, this suggests the need for some investigation. A particular issue is that lack of H&S communication is one of the key factors leading to construction industry accidents/ incidents as it prevents workers from effectively receiving H&S safety training and acquiring H&S information. Migrant workers whose first languages are not English are particularly affected by this problem and ways are needed to improve their situation. The research aims to do this by evaluating the H&S communication problems of migrant workers and identify an effective H&S communication structure. An overview of the challenge being addressed by the research is firstly provided, followed by a description of the research framework, and a report of the initial findings, from which recommendations are provided for improving H&S performance in the construction industry.

Kehittävän kuntoutuksen mahdollisuudet. : Tutkimus Aslak -kuntoutuksen työkytkennän ja asiakkuuden rakentumisesta.

The possibilities of developmental rehabilitation. A study on the construction of work relatedness and the customer in Aslak rehabilitation The challenge of work-related rehabilitation is to anticipate the factors threatening work ability and to affect them. The purpose of this study was to analyze how work-related rehabilitation is constructed in practice and what are the challenges and, at the same time, the possibilities of an innovative transformation of rehabilitation when trying to achive this goal. The theoretical basis is cultural-historical activity theory and developmental work research. Based on a historical analysis, I studied rehabilitation activity empirically using the data gathered from one Aslak programme (Aslak = occupationally oriented medical rehabilitation) over two years. I described and analysed the construction of Aslak using ethnographic data and interviews. The data includes audio- and video-recordings of the Aslak course, fieldnotes, documents and other materials used in the course. The study aimed to reveal rehabilitation practices from different perspectives carried out by different stakeholders and participants in the Aslak course. It focused on the Aslak trajectory produced by a multiorganizational subject. I analyzed the rehabilitation activity using the method of ethnographic analysis of infrastructure. The method of analyzing the construction of the object of rehabilititation the customer was a membership categorization analysis (MCD) based on the ethnomethodological research tradition. I analyzed the meanings denoting customers given by different parties during one Aslak process and the relations between the meanings. Based on this analysis, I studied the disturbances, ruptures, and innovations in the rehabilitation activity. The results of the study show that the infrastructure of Aslak has different basic ideas. Aslak is constructed most explicitly on the infrastructure of medical rehabilitation. The second layer has been provided with some tools of identifying and preventing well-defined occupation-specific load factors. However, it has failed to perform a new structure, as Aslak has encountered, at the same time, rapid changes in working life. The study identified some promising markers representing new kinds of work-related rehabilitation ideas, but they proved to be incomplete and fragile. As a consequence of the multilayered infrastructure, the contents of the Aslak course were split into fragmented phases and disconnected themes, which were blocked in by the master idea of medical orientation. Its relationship to work remained weak and obscure. The categorizations of customers in Aslak were manifold and contradictory. According to the results, the possibilities for transforming work-related rehabilitation lie both in changing the orientation to the customer to be more relevant to changing working life and forging the infrastructural innovations related to this change. The results showed that a new work-relatedeness would be difficult but possible to construct. What is needed is the construction of an infrastructure that will support a coherent master idea of work-related rehabilitation over the entire trajectory of a process. A shared idea of a rehabilitation object must be constructed in close collaboration between different stakeholders, such as Kela (the Social Insurance Institution of Finland), occupational health services, work organizations, and rehabilitation institutes. Key words: Aslak rehabilitation, work-related rehabilitation, development of rehabilitation, customer of rehabilitation, developmental work research, analysis of infrastructure, membership category analysis