Mental health nursing standards and practice indicators for Australia: a review of current literature

There are many changes and challenges facing the mental health care professional working in Australia in the 21st Century. Given the significance of their number and the considerable extent to which care is delivered by them, mental health nurses in particular must be at the forefront of the movement to enhance and improve mental health care. Mental health nurses in Australia must not only keep up with the changes, we should be setting the pace for others across the profession worldwide. The increasingly complex field of mental health nursing demands nurses who are not only equipped to face the challenges but are confident in doing so. Definitive guidelines for practice, clear expectations regarding outcomes and specific means by which to evaluate both practice and outcomes are vital. Strengthening the role and vision of mental health nursing so that there is clarity about both and highlighting core values by which to perform will enable us to become focused on our future and what we can expect to both give to and receive from our chosen profession and how we can, and do, contribute to mental health care. The role of the mental health nurse is undergoing expansion and there are new hurdles to overcome along with the new benefits this brings. To support this, nationally adopted, formalised standards of practice and means by which to measure these, i.e., practice indicators formerly known as clinical indicators, are required. It is important to have national standards and practice indicators because of the variances in the provision of mental health across Australia – different legislation regarding mental health policies and processes, different nursing registration bodies and Nursing Councils, for example – which create additional barriers to cohesion and uniformity. Improvements in the practice of mental health nursing lead to benefits for consumer outcomes as well as the overall quality of mental health care available in Australia. The emphasis on rights-based care, particularly consumer and carer rights, demands evidence-based, up-to-date mental health care delivered by competent, capable professionals. Documented expectations for performance by nurses will provide all involved with yardsticks by which to evaluate outcomes. Flowing on from these benefits are advances in mental health care generally and enhancements to Australia’s reputation and position within the health care arena throughout the world. Currently, the ‘Standards for Practice’ published by the Australian New Zealand College of Mental Health Nurses (ANZCMHN) in 1995 and the practice indicators developed by Skews et al. (2000) provide a less formal guide for mental health nurses working in Australia. While these earlier standards and practice indicators have played some role in supporting mental health nurses they have not been nationally or enthusiastically adopted and there are a multitude of reasons for this. This report reviews the current literature available on practice indicators and standards for practice and describes an evidence-based rationale as to why a review and renewal of these is required and why it is important, not just for mental health nurses but to the field of mental health in general. The term ‘practice indicator’ is used, except where a quotation utilises ‘clinical indicator’, to more accurately reflect the broad spectrum of nursing roles, i.e. not all mental health nursing work involves a clinical role.

Antarctic tourists, wildlife and the environment: Attractions and reactions to Antarctica

Provides background on the development and nature of Antarctic tourism and associated environmental issues, as well as agreements and regulations affecting environmental management in Antarctica. Following an outline of the survey methodology and provision of information on the socioeconomic profiles of the respondents, results of a survey of Antarctic tourists on the Russian registered ship the ‘Akademik Ioffe’ are reported. The importance of Antarctic wildlife as an attraction for these Antarctic tourists is then given particular attention. The study considers amongst other things how important Antarctic wildlife was in convincing these tourists to undertake their trip to Antarctica, the importance to the tourists of seeing different species of wildlife and the relative importance of wildlife compared with other attractions of the tour to Antarctica. Views both prior to and following visits to Antarctica are given. The views of the tourists about selected environmental issues involving Antarctica were canvassed. These are reported and discussed. Amongst the subjects discussed is whether the sampled tourists favour an expansion in tourism to Antarctica and why. An overall assessment completes the study.

Comparative labor market performance of visaed and non-visaed migrants: Pacific islanders in Sydney

Using survey data for Tongan and Samoan migrants in Sydney the effects of visa restrictions on labor market performance of migrants are assessed. Univariate analysis suggests a positive association between unemployment and the unrestricted entry of Samoan step-migrants from New Zealand. A probit model of the determinants of unemployment is estimated with controls for human capital and demographic variables. While human capital endowments are important, visa restrictions do not have a significant effect on either group's employability. Implications for policy are discussed highlighting the complementarities between host country immigration policies and foreign aid programs.

Developing a framework for assessment of the environmental determinants of walking and cycling

The focus for interventions and research on physical activity has moved away from vigorous activity to moderate-intensity activities, such as walking. In addition, a social ecological approach to physical activity research and practice is recommended. This approach considers the influence of the environment and policies on physical activity. Although there is limited empirical published evidence related to the features of the physical environment that influence physical activity, urban planning and transport agencies have developed policies and strategies that have the potential to influence whether people walk or cycle in their neighbourhood. This paper presents the development of a framework of the potential environmental influences on walking and cycling based on published evidence and policy literature, interviews with experts and a Delphi study. The framework includes four features: functional, safety, aesthetic and destination; as well as the hypothesised factors that contribute to each of these features of the environment. In addition, the Delphi experts determined the perceived relative importance of these factors. Based on these factors, a data collection tool will be developed and the frameworks will be tested through the collection of environmental information on neighbourhoods, where data on the walking and cycling patterns have been collected previously. Identifying the environmental factors that influence walking and cycling will allow the inclusion of a public health perspective as well as those of urban planning and transport in the design of built environments. (C) 2002 Elsevier Science Ltd., All rights reserved.

Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women`s health and domestic violence against women

Suicidal behaviours are one of the most important contributors to the global burden of disease among women, but little is known about prevalence and modifiable risk factors in low and middle income countries. We use data from the WHO multi-country study on women`s health and domestic violence against women to examine the prevalence of suicidal thoughts and attempts, and relationships between suicide attempts and mental health status, child sexual abuse, partner violence and other variables. Population representative cross-sectional household surveys were conducted from 2000-2003 in 13 provincial (more rural) and city (urban) sites in Brazil, Ethiopia, japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. 20967 women aged 15-49 years participated. Prevalence of lifetime suicide attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and multivariate logistic regression models were fit to examine factors associated with suicide attempts in each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city): lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25-50% of women with suicidal thoughts in the past four weeks had also visited a health worker in that time. The most consistent risk factors for suicide attempts after adjusting for probable common mental health disorders were: intimate partner violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual abuse and having a mother who had experienced intimate partner violence. Mental health policies and services must recognise the consistent relationship between violence and suicidality in women in low and middle income countries. Training health sector workers to recognize and respond to the consequences of violence may substantially reduce the health burden associated with suicidal behaviour. (C) 2011 Elsevier Ltd. All rights reserved.

Estimating Income Inequality in China Using Grouped Data and the Generalized Beta Distribution

There are two main types of data sources of income distributions in China: household survey data and grouped data. Household survey data are typically available for isolated years and individual provinces. In comparison, aggregate or grouped data are typically available more frequently and usually have national coverage. In principle, grouped data allow investigation of the change of inequality over longer, continuous periods of time, and the identification of patterns of inequality across broader regions. Nevertheless, a major limitation of grouped data is that only mean (average) income and income shares of quintile or decile groups of the population are reported. Directly using grouped data reported in this format is equivalent to assuming that all individuals in a quintile or decile group have the same income. This potentially distorts the estimate of inequality within each region. The aim of this paper is to apply an improved econometric method designed to use grouped data to study income inequality in China. A generalized beta distribution is employed to model income inequality in China at various levels and periods of time. The generalized beta distribution is more general and flexible than the lognormal distribution that has been used in past research, and also relaxes the assumption of a uniform distribution of income within quintile and decile groups of populations. The paper studies the nature and extent of inequality in rural and urban China over the period 1978 to 2002. Income inequality in the whole of China is then modeled using a mixture of province-specific distributions. The estimated results are used to study the trends in national inequality, and to discuss the empirical findings in the light of economic reforms, regional policies, and globalization of the Chinese economy.

Economic Instruments and Regulatory Approaches in Implementing Riparian Revegetation Options: Observations of the Queensland System

Riparian vegetation can be an effective measure for preventing degradation of streambanks and riparian areas. However, riparian revegetation imposes large costs on landholders associated with tree establishment and removal of land from cropping, while providing benefits to downstream landholders, fishers, the local community and environmentalists. Appropriate policy instruments are required to promote sustainable and balanced use of riparian zones. This article analyses the capacity of existing legislation and other instruments to promote restoration of degraded riparian zones on private land. The role of legislation. economic instruments, community engagement and extension programs, in persuading landholders to revegetate riparian areas and improve riparian vegetation cover; is examined in the context ofa small degraded catchment in an intensive farming area in tropical north Queensland. It is found that while legislation and regulations can control undesirable modification of riparian areas, in general they are unable to make a useful contribution to restoration of these areas; incentives and assistance measures appear to offer greater potential.

Translating policy: Power and action in Australia's country towns

Controversies In its present condition, rural Australia is characterised by a discourse of decline that sees country towns and regions as places of demoralisation and despair. From a Foucauldian governmentality perspective, those who live in these spaces are not so much 'powerless' to the demands of urban-based governments and global capital, as rendered governable according to the socio-political ambitions of late capitalism. While important insights have been derived from such analyses, it is argued in this paper that excessive attention is often paid to the power of the state with little concern for the various ways in which local people engage with, and transform the strategies and effects of state power. Rather than utilising the concept of resistance to make sense of these interactions, a sociology of translation is adopted from the Actor Network Theory literature. Applied to two case examples, it shows how governmental policies and programmes are frequently the outcome of the interactions and negotiations that take place between all those enrolled in the actor-network.

Organizational and accounting change within the context of the environmental agenda: evidence from Portugal

Purpose – The purpose of this paper is to explore the process of organizational change undergone by a large Portuguese business group within the context of the environmental agenda and the role of accounting as a mechanism for change. Design/methodology/approach – The paper reports the results of a case study conducted between 2006 and 2009. Information was obtained from semi-structured interviews and secondary sources. Organizational changes were analyzed using Laughlin’s model in order to identify which category reflected most of the changes introduced to address environmental matters. Findings – This paper offers evidence that change is not a homogeneous phenomenon. Additionally, it confirms previous studies’ findings which found that accounting did not play a significant role in the process of organizational change within the context of the environmental agenda. Originality/value – This paper seeks to complement the research in this area by integrating observations from a case study into an existing model of levels of organizational change according to how a Portuguese business group incorporated environmental issues into its processes, policies and corporate culture.

Monetary channels of social inclusion: a case study of basic income and the Caixa Econômica Federal in Brazil

This article reports evidence of new monetary channels for social inclusion involving basic income policies and the Caixa Econômica Federal, a Brazilian government savings bank. Since the Plano Real (Brazilian currency) and the liberalization of banking in the 1990s, the realization of competitive advantages by the Caixa as social policy agent and the importance of citizenship cards differ from existing theories of bank change, financial inclusion and monetary policy. Multi-method research reveals the importance of 1) political theories of basic income, 2) conceptions of citizenship and social justice, and 3) a back to the future modernization of government banking. This provides alternatives to contemporary market-based banking theory, neo-liberal policies, private and non-governmental microfinance strategies, and theories in political economy about fiscal constraints to social policies. New monetary channels of change also suggest that zero sum theories about politics, monetary authority and social inclusion are amiss.

Demand response programs definition supported by clustering and classification techniques

The growing importance and influence of new resources connected to the power systems has caused many changes in their operation. Environmental policies and several well know advantages have been made renewable based energy resources largely disseminated. These resources, including Distributed Generation (DG), are being connected to lower voltage levels where Demand Response (DR) must be considered too. These changes increase the complexity of the system operation due to both new operational constraints and amounts of data to be processed. Virtual Power Players (VPP) are entities able to manage these resources. Addressing these issues, this paper proposes a methodology to support VPP actions when these act as a Curtailment Service Provider (CSP) that provides DR capacity to a DR program declared by the Independent System Operator (ISO) or by the VPP itself. The amount of DR capacity that the CSP can assure is determined using data mining techniques applied to a database which is obtained for a large set of operation scenarios. The paper includes a case study based on 27,000 scenarios considering a diversity of distributed resources in a 33 bus distribution network.

Effects of health decentralization, financing and governance in Mexico

OBJECTIVE: To identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers. METHODS: A cross-sectional study was carried out in four states that were selected according to geopolitical and administrative criteria. Four indicators were assessed: changes and effects on governance, financing sources and funds, the final destination of resources, and fund allocation mechanisms. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. The interviews were transcribed and analyzed by thematic segmentation. RESULTS: The results show different effectiveness levels for the four states regarding changes in financing policies and community participation. Effects on health financing after decentralization were identified in each state, including: greater participation of municipal and state governments in health expenditure, increased financial participation of households, greater community participation in low-income states, duality and confusion in the new mechanisms for coordination among the three government levels, absence of an accountability system, lack of human resources and technical skills to implement, monitor and evaluate changes in financing. CONCLUSIONS: In general, positive and negative effects of decentralization on health financing and governance were identified. The effects mentioned by health service providers and users were related to a diversification of financing sources, a greater margin for decisions around the use and final destination of financial resources and normative development for the use of resources. At the community level, direct financial contributions were mentioned, as well as in-kind contributions, particularly in the form of community work.

Gestão de informação pessoal em saúde

O sistema de gestão de proteção de dados pessoais e estudos clínicos em Portugal levanta controvérsia e uma interpretação distinta, dada a sensibilidade ética do tema, a integridade humana. Além deste fato, estamos diante de um problema que envolve diversos interesses e, assim, um confronto de posições. Pretende-se, ao longo deste artigo, abordar a percepção da forma como os profissionais da área da saúde, no seu quotidiano, lidam com a questão do tratamento de dados clínicos, numa tentativa de harmonizar pontos de vista e de conteúdo, verificando se há realmente um esforço das instituições hospitalares para facilitarem este processo e permitirem que os usuários sejam universalmente protegidos e bem tratados. Os resultados obtidos no documento de consulta de profissionais de saúde indicam que há uma preocupação com a confidencialidade em 100% dos inquiridos, embora existam sistemas de gestão de dados clínicos diferenciados (seis distintos). Espera-se uma tendência ascendente na procura dessas informações úteis e de interesse para deter essa informação, tomada por profissionais de saúde, instituições de saúde, seguradoras etc. O problema surge no confronto entre a proteção da vida privada, o interesse específico de usuários, o interesse público e as políticas institucionais e governamentais vigentes. Partindo do pressuposto de que a garantia de confidencialidade é uma realidade em termos de segurança, é necessário determinar se os meios utilizados para atingir essa tarefa são os mais eficientes e permitem uma gestão sustentável dos dados de saúde.

Trends in public health policies addressing violence against women

OBJECTIVE To analyze the content of policies and action plans within the public healthcare system that addresses the issue of violence against women.METHODS A descriptive and comparative study was conducted on the health policies and plans in Catalonia and Costa Rica from 2005 to 2011. It uses a qualitative methodology with documentary analysis. It is classified by topics that describe and interpret the contents. We considered dimensions, such as principles, strategies, concepts concerning violence against women, health trends, and evaluations.RESULTS Thirteen public policy documents were analyzed. In both countries’ contexts, we have provided an overview of violence against women as a problem whose roots are in gender inequality. The strategies of gender policies that address violence against women are cultural exchange and institutional action within the public healthcare system. The actions of the healthcare sector are expanded into specific plans. The priorities and specificity of actions in healthcare plans were the distinguishing features between the two countries.CONCLUSIONS The common features of the healthcare plans in both the counties include violence against women, use of protocols, detection tasks, care and recovery for women, and professional self-care. Catalonia does not consider healthcare actions with aggressors. Costa Rica has a lower specificity in conceptualization and protocol patterns, as well as a lack of updates concerning health standards in Catalonia.

Federalism and health policy: the intergovernmental committees in Brazil

OBJECTIVE To analyze the dynamics of operation of the Bipartite Committees in health care in the Brazilian states.METHODS The research included visits to 24 states, direct observation, document analysis, and performance of semi-structured interviews with state and local leaders. The characterization of each committee was performed between 2007 and 2010, and four dimensions were considered: (i) level of institutionality, classified as advanced, intermediate, or incipient; (ii) agenda of intergovernmental negotiations, classified as diversified/restricted, adapted/not adapted to the reality of each state, and shared/unshared between the state and municipalities; (iii) political processes, considering the character and scope of intergovernmental relations; and (iv) capacity of operation, assessed as high, moderate, or low.RESULTS Ten committees had advanced level of institutionality. The agenda of the negotiations was diversified in all states, and most of them were adapted to the state reality. However, one-third of the committees showed power inequalities between the government levels. Cooperative and interactive intergovernmental relations predominated in 54.0% of the states. The level of institutionality, scope of negotiations, and political processes influenced Bipartite Committees’ ability to formulate policies and coordinate health care at the federal level. Bipartite Committees with a high capacity of operation predominated in the South and Southeast regions, while those with a low capacity of operations predominated in the North and Northeast.CONCLUSIONS The regional differences in operation among Bipartite Interagency Committees suggest the influence of historical-structural variables (socioeconomic development, geographic barriers, characteristics of the health care system) in their capacity of intergovernmental health care management. However, structural problems can be overcome in some states through institutional and political changes. The creation of federal investments, varied by regions and states, is critical in overcoming the structural inequalities that affect political institutions. The operation of Bipartite Committees is a step forward; however, strengthening their ability to coordinate health care is crucial in the regional organization of the health care system in the Brazilian states.