903 resultados para physician attitude


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Building construction is a highly competitive and risky business. This competitiveness is compounded where conflicting objectives amongst contracting and subcontracting firms set the stage for an adversarial and potentially destructive business relationship. Clients, especially those from the public sector, need broader tender evaluation criteria to complement the traditional focus on bid price. There is also a need for change in the construction industry—not only to a more cooperative approach between the constructing parties—but also from a confrontationist attitude to a more harmonious relationship between all stakeholders in providing constructed facilities. A strategic alliance is a cooperative relationship between two or more organisations that forms part of their overall strategies, and contributes to achieving their major goals and objectives. Strategic alliances in building construction may provide a useful tool to assist public sector construction managers evaluate tenders and concurrently encourage more cooperative relationships amongst construction stakeholders. This paper begins with an overview of the Australian building construction industry, then reviews the existing strategic alliance literature and describes an analysis framework comprising six attributes of strategic alliances for application to construction organisations—trust, commitment, interdependence, cooperation, communication, and joint problem solving. These attributes are currently being used to collect data from 70 building construction firms in Queensland to assess their respective levels of strategic alliance. Given the trend towards broader indicators of construction firm performance, these attributes are proposed as a tool for use in the tender evaluation process for public works.

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In Australia and other developed countries there is poor adherence to guidelines recommending the introduction of complementary feeding to infants at 6 months of age. We aimed to investigate, via adopting a theory of planned behaviour framework and incorporating additional normative and demographic influences, mothers’ complementary feeding intentions and behaviour. Participants were 375 primiparas who completed an initial questionnaire (infant age 13±3weeks) that assessed the theory of planned behaviour constructs of attitude, subjective norm, and perceived behavioural control, as well as group norm and additional maternal and infant variables of mothers’ age, education level, weight status perception, current maternal feeding practices, and infant birth weight. Approximately, 3 months after completion of the main questionnaire, mothers completed a follow-up questionnaire that assessed the age in months at which the infant was first introduced to solids. The theory of planned behaviour variables of attitude and subjective norm, along with group norm, predicted intentions, with intention, mothers’ age (older more likely), and weight status perception (overweight less likely) predicting behaviour. Overall, the results highlight the importance of attitudes, normative influences, and individual characteristics in complementary feeding decision-making which should be considered when designing interventions aimed at improving adherence to current maternal feeding guidelines.

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This thesis conceptualises Use for IS (Information Systems) success. While Use in this study describes the extent to which an IS is incorporated into the user’s processes or tasks, success of an IS is the measure of the degree to which the person using the system is better off. For IS success, the conceptualisation of Use offers new perspectives on describing and measuring Use. We test the philosophies of the conceptualisation using empirical evidence in an Enterprise Systems (ES) context. Results from the empirical analysis contribute insights to the existing body of knowledge on the role of Use and demonstrate Use as an important factor and measure of IS success. System Use is a central theme in IS research. For instance, Use is regarded as an important dimension of IS success. Despite its recognition, the Use dimension of IS success reportedly suffers from an all too simplistic definition, misconception, poor specification of its complex nature, and an inadequacy of measurement approaches (Bokhari 2005; DeLone and McLean 2003; Zigurs 1993). Given the above, Burton-Jones and Straub (2006) urge scholars to revisit the concept of system Use, consider a stronger theoretical treatment, and submit the construct to further validation in its intended nomological net. On those considerations, this study re-conceptualises Use for IS success. The new conceptualisation adopts a work-process system-centric lens and draws upon the characteristics of modern system types, key user groups and their information needs, and the incorporation of IS in work processes. With these characteristics, the definition of Use and how it may be measured is systematically established. Use is conceptualised as a second-order measurement construct determined by three sub-dimensions: attitude of its users, depth, and amount of Use. The construct is positioned in a modified IS success research model, in an attempt to demonstrate its central role in determining IS success in an ES setting. A two-stage mixed-methods research design—incorporating a sequential explanatory strategy—was adopted to collect empirical data and to test the research model. The first empirical investigation involved an experiment and a survey of ES end users at a leading tertiary education institute in Australia. The second, a qualitative investigation, involved a series of interviews with real-world operational managers in large Indian private-sector companies to canvass their day-to-day experiences with ES. The research strategy adopted has a stronger quantitative leaning. The survey analysis results demonstrate the aptness of Use as an antecedent and a consequence of IS success, and furthermore, as a mediator between the quality of IS and the impacts of IS on individuals. Qualitative data analysis on the other hand, is used to derive a framework for classifying the diversity of ES Use behaviour. The qualitative results establish that workers Use IS in their context to orientate, negotiate, or innovate. The implications are twofold. For research, this study contributes to cumulative IS success knowledge an approach for defining, contextualising, measuring, and validating Use. For practice, research findings not only provide insights for educators when incorporating ES for higher education, but also demonstrate how operational managers incorporate ES into their work practices. Research findings leave the way open for future, larger-scale research into how industry practitioners interact with an ES to complete their work in varied organisational environments.

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Many studies carried out in relation to construction procurement methods reveal evidence of a need to change of culture and attitude in the construction industry. This culture change would transition from traditional adversarial relationships to cooperative and collaborative relationships. Relational contracting approaches, such as partnering and relationship management, are business strategies whereby client, commercial participants’ and stakeholders’ objectives are aligned for mutual benefit. The efficacy of relationship management in the client and contractor groups is proven and well documented. However, the industry has a slow implementation of relational contracting down the value chain. This paper reports the findings of an empirical study which examined the practices and prerequisites for relationship management implementation success and for supply chain engagement to develop. Questionnaire survey, interviews and case studies were conducted with Australian contracting organisations in this study. The study reveals that the adaption of relational contracting approach in the supply chain is found to be limited and contractors still prefer to keep suppliers and subcontractors at arm’s length. Findings also show that the degree of match and mismatch between organizational structuring and organizational process is found to have an impact on staff’s commitment level and performance effectiveness.

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The Reporting and Reception of Indigenous Issues in the Australian Media was a three year project financed by the Australian government through its Australian Research Council Large Grants Scheme and run by Professor John Hartley (of Murdoch and then Edith Cowan University, Western Australia). The purpose of the research was to map the ways in which indigeneity was constructed and circulated in Australia's mediasphere. The analysis of the 'reporting' element of the project was almost straightforward: a mixture of content analysis of a large number of items in the media, and detailed textual analysis of a smaller number of key texts. The discoveries were interesting - that when analysis approaches the media as a whole, rather than focussing exclusively on news or serious drama genres, then representation of indigeneity is not nearly as homogenous as has previously been assumed. And if researchers do not explicitly set out to uncover racism in every text, it is by no means guaranteed they will find it1. The question of how to approach the 'reception' of these issues - and particularly reception by indigenous Australians - proved to be a far more challenging one. In attempting to research this area, Hartley and I (working as a research assistant on the project) often found ourselves hampered by the axioms that underlie much media research. Traditionally, the 'reception' of media by indigenous people in Australia has been researched in ethnographic ways. This research repeatedly discovers that indigenous people in Australia are powerless in the face of new forms of media. Indigenous populations are represented as victims of aggressive and powerful intrusions: ‘What happens when a remote community is suddenly inundated by broadcast TV?’; ‘Overnight they will go from having no radio and television to being bombarded by three TV channels’; ‘The influence of film in an isolated, traditionally oriented Aboriginal community’2. This language of ‘influence’, ‘bombarded’, and ‘inundated’, presents metaphors not just of war but of a war being lost. It tells of an unequal struggle, of a more powerful force impinging upon a weaker one. What else could be the relationship of an Aboriginal audience to something which is ‘bombarding’ them? Or by which they are ‘inundated’? This attitude might best be summed up by the title of an article by Elihu Katz: ‘Can authentic cultures survive new media?’3. In such writing, there is little sense that what is being addressed might be seen as a series of discursive encounters, negotiations and acts of meaning-making in which indigenous people — communities and audiences —might be productive. Certainly, the points of concern in this type of writing are important. The question of what happens when a new communication medium is summarily introduced to a culture is certainly an important one. But the language used to describe this interaction is a misleading one. And it is noticeable that such writing is fascinated with the relationship of only traditionally-oriented Aboriginal communities to the media of mass communication.

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The very act of withdrawing dialysis places renal nurses in a unique practice setting requiring a sudden shift in care delivery from one of providing Ife-sustaining, active treatment to that of palliation. The impact of this act on the renal nurse remains largely invisible. Minimal research has been conducted that explores the significant issues and challenges that exist for renal nurses in the delivery of palliation following withdrawal of dialysis treatment. This paper attempts to highlight the issues and challenges that do exist for renal nurses in providing palliation and the subsequent lack of available research knowledge to inform practice in the renal setting. It recommends further research be conducted into the renal setting so as to inform the development of appropriate education to support renal nurses practice in the future.

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Background: Mentoring is often proposed as a solution to the problem of successfully recruiting and retaining nursing staff. The aim of this constructivist grounded theory study was to explore Australian rural nurses' experiences of mentoring. Design: The research design used was reflexive in nature resulting in a substantive, constructivist grounded theory study. Participants: A national advertising campaign and snowball sampling were used to recruit nine participants from across Australia. Participants were rural nurses who had experience in mentoring others. Methods: Standard grounded theory methods of theoretical sampling, concurrent data collection and analysis using open, axial and theoretical coding and a story line technique to develop the core category and category saturation were used. To cultivate the reflexivity required of a constructivist study, we also incorporated reflective memoing, situational analysis mapping techniques and frame analysis. Data was generated through eleven interviews, email dialogue and shared situational mapping. Results: Cultivating and growing new or novice rural nurses using supportive relationships such as mentoring was found to be an existing, integral part of experienced rural nurses' practice, motivated by living and working in the same communities. Getting to know a stranger is the first part of the process of cultivating and growing another. New or novice rural nurses gain the attention of experienced rural nurses through showing potential or experiencing a critical incidence. Conclusions: The problem of retaining nurses is a global issue. Experienced nurses engaged in clinical practice have the potential to cultivate and grow new or novice nurses-many already do so. Recognising this role and providing opportunities for development will help grow a positive, supportive work environment that nurtures the experienced nurses of tomorrow.

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Aim. Our aim in this paper is to explain a methodological/methods package devised to incorporate situational and social world mapping with frame analysis, based on a grounded theory study of Australian rural nurses' experiences of mentoring. Background. Situational analysis, as conceived by Adele Clarke, shifts the research methodology of grounded theory from being located within a postpositivist paradigm to a postmodern paradigm. Clarke uses three types of maps during this process: situational, social world and positional, in combination with discourse analysis. Method. During our grounded theory study, the process of concurrent interview data generation and analysis incorporated situational and social world mapping techniques. An outcome of this was our increased awareness of how outside actors influenced participants in their constructions of mentoring. In our attempts to use Clarke's methodological package, however, it became apparent that our constructivist beliefs about human agency could not be reconciled with the postmodern project of discourse analysis. We then turned to the literature on symbolic interactionism and adopted frame analysis as a method to examine the literature on rural nursing and mentoring as secondary form of data. Findings. While we found situational and social world mapping very useful, we were less successful in using positional maps. In retrospect, we would argue that collective action framing provides an alternative to analysing such positions in the literature. This is particularly so for researchers who locate themselves within a constructivist paradigm, and who are therefore unwilling to reject the notion of human agency and the ability of individuals to shape their world in some way. Conclusion. Our example of using this package of situational and social worlds mapping with frame analysis is intended to assist other researchers to locate participants more transparently in the social worlds that they negotiate in their everyday practice. © 2007 Blackwell Publishing Ltd.

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Major curriculum and assessment reforms in Australia have generated research interest in issues related to standards, teacher judgement and moderation. This article is based on one related inquiry of a large-scale Australian Research Council Linkage project conducted in Queensland. This qualitative study analysed interview data to identify teachers’ views on standards and moderation as a means to achieving consistency of teacher judgement. A complementary aspect of the research involved a blind review that was conducted to determine the degree of teacher consistency without the experience of moderation. Empirical evidence was gained that most teachers, of the total interviewed, articulated a positive attitude towards the use of standards in moderation and perceived that this process produces consistency in teachers’ judgements. Context was identified as an important influential factor in teachers’ judgements and it was concluded that teachers’ assessment beliefs, attitudes and practices impact on their perceptions of the value of moderation practice and the extent to which consistency can be achieved.

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Public awareness and concern about cosmetic surgery on children is increasing. Nationally and internationally questions have been raised by the media and government bodies about the appropriateness of children undergoing cosmetic surgery. Considering the rates of cosmetic surgery in comparable Western societies, it seems likely that the number of physicians in Australia who will deal with a request for cosmetic surgery for a child will continue to increase. This is a sensitive issue and it is essential that physicians understand the professional and legal obligations that arise when cosmetic surgery is proposed for a child.

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This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the role of knowledge in expert practice. Using grounded theory methodology, the study involved 17 registered nurses who were practicing in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participants' observations and interviews. Having extensive nephrology nursing knowledge was a striking characteristic of a nursing expert. Expert nurses clearly relied on and utilized extensive nephrology nursing knowledge to practice. Of importance for nursing, the results of this study indicate that domain-specific knowledge is a crucial feature of expert practice.

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Expertise in nursing has been widely studied although there have been no previous studies into what constitutes expertise in nephrology (renal) nursing. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, provides evidence of the characteristics and practices of non-expert nephrology nurses. Using the grounded theory method, the study took place in one renal unit in New South Wales, Australia, and involved six non-expert and 11 expert nurses. Sampling was purposive then theoretical. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semistructured interviews was undertaken. The study revealed a three-stage skills-acquisitive process that was identified as non-expert, experienced non-expert and expert stages. Non-expert nurses showed superficial nephrology nursing knowledge and limited experience; they were acquiring basic nephrology nursing skills and possessed a narrow focus of practice.

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Aims and objectives. This purpose of this study was to describe the process of expertise acquisition in nephrology nursing practice. Background. It has been recognized for a number of decades that experts, compared with other practitioners in a number of professions and occupations, are the most knowledgeable and effective, in terms of both the quantity and quality of output. Studies relating to expertise have been undertaken in a range of nursing contexts and specialties; to date, however, none have been undertaken which focus on nephrology nursing. Design. This study, using grounded theory methodology, took place in one renal unit in New South Wales, Australia and involved six non-expert and 11 expert nurses. Methods. Simultaneous data collection and analysis took place using participant observation, semi-structured interviews and review of nursing documentation. Findings. The study revealed a three-stage skills-acquisitive process that was identified as non-expert, experienced non-expert and expert stages. Each stage was typified by four characteristics, which altered during the acquisitive process; these were knowledge, experience, skill and focus. Conclusion. This was the first study to explore nephrology nursing expertise and uncovered new aspects of expertise not documented in the literature and it also made explicit other areas, which had only been previously implied. Relevance to clinical practice. Of significance to nursing, the exercise of expertise is a function of the recognition of expertise by others and it includes the blurring of the normal boundaries of professional practice. © 2006 Blackwell Publishing Ltd.

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We suspect that the array of silly names used to refer to temporary staff worldwide may be indicative of the extent to which these nurses have been relegated to, and we would argue, remain in, a type of underclass – relatively unsupported by employers in terms of professional practice and ipso facto excluded from contributing professionally to team work, practice development, clinical governance and evidence based practice. This may be acceptable to some but in a climate of risk averseness and in the interests of strategic planning we would suggest it is an accident waiting to happen. The recent UK Royal College of Nursing (RCN) (Ball & Pike, 2006) survey of bank and agency nurses brings a welcome focus on a group of nurses that make a significant contribution to the smooth running of health services in many countries.

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