Therapeutic relationships in specialist palliative care nursing practice.

There has been limited research into the scope or standards of specialist palliative care nursing practice in an Australian context. This study sought to develop a competency framework that described the core domains of specialist palliative care nursing. This article explores one key domain of specialist palliative care nursing practice - therapeutic relationships - that was identified as underpinning other domains of practice. A mixed method was used, involving a literature review, a survey including practice exemplars and an interview of specialist palliative care nurses. Seventy-four registered nurses working in designated specialist palliative care nursing roles from each Australian state and mainland territory were involved. The nurses represented metropolitan, regional, rural and remote communities, various inpatient facilities and community practice settings. Five core domains of specialist palliative care nursing practice were identified: complex supportive care, collaborative practice, leadership, improving practice and therapeutic relationships. Therapeutic relationships were identified as the central domain of specialist palliative care nursing practice to which all other domains were inextricably linked.

Audit of the Care of the Dying in a Network of Hospitals and Institutions in Queensland

Background: Most Australians die in institutions and there is evidence to suggest that the care of these patients is not always optimal. Care pathways for the dying have been designed to transfer benchmarked hospice care to other settings (e.g. acute hospitals and residential age-care facilities) by defining goals of best care, providing guidelines to provide that care and documenting outcome. Method: A retrospective audit was undertaken across a network of health-care institutions in Queensland. The 18 goals considered essential for the care of the dying within the Liverpool Care Pathway were taken as a benchmark. Documentation of achievement of each of these goals was sought. Results: The notes of 160 patients who had died in eight institutions (four hospitals, three hospices, one nursing home) were reviewed. Several areas for improvement were identified, particularly in those goals relating to communication, resuscitation orders and care after death. Few units documented the provision of written information to families. Most patients were prescribed medications in anticipation of pain and agitation but less were prescribed drugs for other common symptoms in the dying. Most of the goals were achieved in a higher percentage of cases in hospice units. Marked differences in practice were noted between different institutions. Conclusion: The audit identified several aspects in the care of the terminally ill that could be improved. End-stage pathways may provide a model for improving the care of patients dying in hospitals and institutions in Australia.

Developing the Primary Palliative Care Workforce in Australia

Current healthcare models promote the equitable provision of palliative care to oncology patients with advancing disease, in the setting of their usual care, often in conjunction with anti-cancer therapies. This has resulted in specialist cancer services, as well as primary care across metropolitan, rural and remote communities, being called upon to integrate palliative care principles into their practice. To meet this increased demand for skilled health care professionals several national strategies have been initiated over the last five years. In this paper two projects are discussed in detail: the Palliative Care Curriculum for Undergraduates and the Program of Experience in the Professional Approach.

The core role of the nurse practitioner: practice, professionalism and clinical leadership.

AIM: To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. BACKGROUND: Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally. METHOD: This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data. FINDINGS: The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care. CONCLUSION: A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide new perspectives to inform the international debate about this extended level of nursing practice. RELEVANCE TO CLINICAL PRACTICE: The findings from this research have the potential to achieve a standardised approach and internationally consistent nomenclature for the nurse practitioner role.

UAS Mission Path Planning System, (MPPS) using hybrid-game coupled to multi-objective optimizer

This paper presents the application of advanced optimization techniques to unmanned aerial system mission path planning system (MPPS) using multi-objective evolutionary algorithms (MOEAs). Two types of multi-objective optimizers are compared; the MOEA nondominated sorting genetic algorithm II and a hybrid-game strategy are implemented to produce a set of optimal collision-free trajectories in a three-dimensional environment. The resulting trajectories on a three-dimensional terrain are collision-free and are represented by using Bézier spline curves from start position to target and then target to start position or different positions with altitude constraints. The efficiency of the two optimization methods is compared in terms of computational cost and design quality. Numerical results show the benefits of adding a hybrid-game strategy to a MOEA and for a MPPS.

A planning support system for airport city development

Many airports around the world are diversifying their land use strategies to integrate non-aeronautical development. These airports embrace the “airport city” concept to develop a wide range of commercial and light industrial land uses to support airport revenues. The consequences of this changing urban form are profound for both airport and municipal planners alike and present numerous challenges with regard to integration of airport and regional planning. While several tools exist for regional planning and airport operational planning, no holistic airport landside and regional planning tool exist. What is required is a planning support system that can integrate the sometimes conflicting stakeholder interests into one common goal for the airport and the surrounding region. This paper presents a planning support system and evaluates its application to a case study involving Brisbane Airport and the South East Queensland region in Australia.

Challenges in land use planning around Australian airports

The privatization of major Australian airports in the late 1990s unleashed an unprecedented development wave as corporate lessees implemented ambitious business plans. While planning and environmental regulations governing on-airport development were significantly enhanced, there has been national disquiet about a governance regime that remains under the auspices of the federal government and is not effectively integrated into state and local decision-making machinery. Tensions in major airport regions have been exacerbated by the building of highly conspicuous non-aeronautical developments approved with no determining input by local decision-makers as well as the growing pressures on off-airport locations for aviation-related development. This paper canvasses this context and overviews the evolving structure of planning controls for Australia’s privatized federal airports. A range of issues surfacing through the National Aviation Policy Review process in 2008–2009 is described.

Web-based and traditional public participation in comprehensive planning : a comparative study

The present paper examines whether the potential advantages of the expanding practice of web-based public participation only complement the benefits of the traditional techniques, or are empowering enough to replace them. The question is examined in a real-world case of neighbourhood revitalization, in which both techniques were practiced simultaneously. Comparisons are made at four major planning junctions, in order to study the contributions of each technique to the qualities of involvement, trust, and empowerment. The results show that web-based participants not only differ from the participants of traditional practices, but they also differ from each other on the basis of their type of web participation. The results indicate that web-based participation is an effective and affective complementary means of public participation, but it cannot replace the traditional unmediated techniques.

A naturalistic inquiry of registered nurses' perspectives and expectations of psychodynamic therapeutic care in acute psychiatric inpatient facilities

Within contemporary inpatient mental health nursing practice, the psychodynamic model of care considered previously to be central to the nurse-patient relationship now seems a radical concept. It appears to exist only within primary care facilities and public health care practice settings. This naturalistic inquiry aimed to explicate mental health nurses' perspectives and expectations of providing psychodynamic therapeutic care in acute inpatient psychiatric facilities. Ten registered nurses working in acute inpatient mental health facilities were interviewed. Five themes emerged: a career for life, relating in a psychodynamic manner, swimming against the current, adopting a position of difference, and hopeful expectancy.

Validity of the Waterlow screening tool and risks for pressure injury in acute care

Objectives: To assess the validity of the Waterlow screening tool in a cohort of internal medicine patients and to identify factors contributing to pressure injury. Design: Longitudinal cohort study Setting: A tertiary hospital in Brisbane, Australia Participants: 274 patients admitted through the Emergency Department or outpatient clinics and expected to remain in hospital for at least three days were included in the study. The mean age was 65.3 years. Interventions: Patients were screened on admission using the Waterlow screening tool. Every second day, their pressure ulcer status was monitored and recorded. Main outcome measures: Pressure ulcer incidence Results: Fifteen participants (5.5%) had an existing pressure ulcer and a further 12 (4.4%) developed a pressure ulcer during their hospital stay. Sensitivity of the Waterlow scale was 0.67, (95% CI: 0.35 to 0.88); specificity 0.79, (95% CI: 0.73 to 0.85); PPV 0.13, (95% CI: 0.07 to 0.24); NPV 0.98, (95% CI: 0.94 to 0.99). Conclusion: This study provides further evidence of the poor predictive validity of the Waterlow scale. A suitably powered randomised controlled trial is urgently needed to provide definitive evidence about the usefulness of the Waterlow scale compared with other screening tools and with clinical judgement.

The ethics of regional water planning : planning and management of water resources in a growth region

Abstract Providing water infrastructure in times of accelerating climate change presents interesting new problems. Expanding demands must be met or managed in contexts of increasingly constrained sources of supply, raising ethical questions of equity and participation. Loss of agricultural land and natural habitats, the coastal impacts of desalination plants and concerns over re-use of waste water must be weighed with demand management issues of water rationing, pricing mechanisms and inducing behaviour change. This case study examines how these factors impact on infrastructure planning in South East Queensland, Australia: a region with one of the developed world’s most rapidly growing populations, which has recently experienced the most severe drought in its recorded history. Proposals to match forecast demands and potential supplies for water over a 20 year period are reviewed by applying ethical principles to evaluate practical plans to meet the water needs of the region’s activities and settlements.

Planning infrastructure : considerations for regional development

Current rapid increases in the scope of regional development and the reach of technology have combined with the expanding scale of modern settlements to focus growing attention on infrastructure provisionneeds. This has included organisational and funding systems, the management of new technologies and regional scale social provisions. In this chapter, the evolution of urban and regional infrastructure is traced from its earliest origins in the growth of organized societies of 5 ,000 years ago. Infrastructure needs and provision are illustrated for the arenas of metropolitan, provincial and rural regions. Rural infrastructure examples and lessons are drawn from global case studies. Recent expansions of the scope of infrastructure are examined and issues of governance and process discussed. Phased planning processes are related to cycles of program adoption, objective formulation, option evaluation and programme budgeting. Issues of privatisation and public interest are considered. Matters of contemporary global significance are explored, including the current economic contraction and the effects of global climate change. Conclusions are drawn about the role and importance of linking regional planning to coherent regional infrastructure programs and budgets

Knowledge-based approach for planning healthy cities : the case of Logan-Beaudesert, Australia

Introduction - The planning for healthy cities faces significant challenges due to lack of effective information, systems and a framework to organise that information. Such a framework is critical in order to make accessible and informed decisions for planning healthy cities. The challenges for planning healthy cities have been magnified by the rise of the healthy cities movement, as a result of which, there have been more frequent calls for localised, collaborative and knowledge-based decisions. Some studies have suggested that the use of a ‘knowledge-based’ approach to planning will enhance the accuracy and quality decision-making by improving the availability of data and information for health service planners and may also lead to increased collaboration between stakeholders and the community. A knowledge-based or evidence-based approach to decision-making can provide an ‘out-of-the-box’ thinking through the use of technology during decision-making processes. Minimal research has been conducted in this area to date, especially in terms of evaluating the impact of adopting knowledge-based approach on stakeholders, policy-makers and decision-makers within health planning initiatives. Purpose – The purpose of the paper is to present an integrated method that has been developed to facilitate a knowledge-based decision-making process to assist health planning Methodology – Specifically, the paper describes the participatory process that has been adopted to develop an online Geographic Information System (GIS)-based Decision Support System (DSS) for health planners. Value – Conceptually, it is an application of Healthy Cities and Knowledge Cities approaches which are linked together. Specifically, it is a unique settings-based initiative designed to plan for and improve the health capacity of Logan-Beaudesert area, Australia. This setting-based initiative is named as the Logan-Beaudesert Health Coalition (LBHC). Practical implications - The paper outlines the application of a knowledge-based approach to the development of a healthy city. Also, it focuses on the need for widespread use of this approach as a tool for enhancing community-based health coalition decision making processes.

Collaborative voices: Ongoing reflections on cultural competency and the health care of Australian Indigenous people

The issue of cultural competency in health care continues to be a priority in Australia for health and human services professionals. Cultural competence in caring for Aboriginal and Torres Strait Islander peoples is of increasing interest, and is a priority in closing the gap in health disparities between Indigenous and non-Indigenous Australians. Through a collaborative conversation, the authors draw on a case study, personal experience and the literature to highlight some of the issues associated with employing culturally appropriate, culturally safe and culturally competent approaches when caring for Aboriginal and Torres Strait Islander peoples. The intent of this article is to encourage discussion on the topic of cultural competency, and to challenge health professionals and academics to think and act on racism, colonialism, historical circumstances and the political, social, economic, and geographical realms in which we live and work, and which all impact on cultural competency.

Health promotion in palliative care : the case for conceptual congruence

This article provides a critical review of the literature relevant to the conceptual foundations of health promoting palliative care. It explores the separate emergence and evolution of palliative care and health promotion as distinct concerns in health care, and reviews the early considerations given to their potential convergence. Finally, this article examines the proposal of health promoting palliative care as a specific approach to providing end of life care through a social model of palliative care. Research is needed to explore the impact for communities, health care services and policy when such an approach is implemented within palliative care organisations.