Preventing falls among older people : current practice and attitudes among community pharmacists

Objective: Falls among older people are a major cause of injury and death in Australia Urgent action is required if we are to stem the .epidemic' increase in falls as our population ages. This paper describes current practice and attitudes of community pharmacists in Northern Rivers, New South Wales, in relation to preventing falls. .. Method: Comm~typhannacists in the Northern Rivers area ofNew South Wales were surveyed to detennine their current activities to reduce the risk of falls in older clients and to gauge awareness of the successful 1992-96 falls prevention program- 'Stay on Your Feet'. Results: Response rate was 79% (53/67). Seventy-two per cent reported that they urge 'most' or 'almost all' older clients to bring in out-of-date medications for disposal, 66% give them falls prevention advice at least 'sometimes', 57% refer at least 'some' older clients to allied health practitioners for assessment or treatment of falls risk. and 92% are interested in receiving more written information regarding falls prevention. Conclusion: The fmdings suggest that while community pharmacists are both ready and keen to play a role in future falls prevention initiatives. their current involvement varies considerably. Specific ways in which they might further help to reduce falls are: regularly checking the potential of client. medications to connibute to falls. giving more verbal or written advice, promoting 'falls safe' products, referring older clients to allied health practitioners for assessment or treatment of falls risk, and training staff [Q provide falls prevention advice

Nursing work and nursing knowledge : exploring the work of women's health nurses, patterns of power and praxis

The majority of women's health nurses in this study work in generalist community health centres. They have developed their praxis within the philosophy and policies of the broader women's health movement and primary health care principles in Australia. The fundamental assumption underlying this study is that women's health nurses possess a unique body of knowledge and clinical wisdom that has not been previously documented and explored. The epistemological base from which these nurses' operate offers important insights into the substantive issues that create and continually shape the practice world of nurses and their clients. Whether this represents a (re)construction of the dominant forms of health care service delivery for women is examined in this study. The study specifically aims at exploring the practice issues and experience of women's health service provision by women's health nurses in the context of the provision of cervical cancer screening services. In mapping this particular group of nurses practice, it sets out to examine the professional and theoretical issues in contemporary nursing and women's health care. In critically analysing the powerful discourses that shape and reshape nursing work, the study raises the concern that previous analyses of pursing work tend to universalise the structural and social subordination of nurses and nursing knowledge. This universalism is most often based on examples of midwifery and nursing work in hospital settings, and subsequently, because of these conceptualisations, all of nursing is too often deemed as a dependent occupation, with little agency, and is analysed as always in relation to medicine, to hospitals, to other knowledge forms. Denoting certain discourses as dominant proposes a relationship of power and knowledge and the thesis argues that all work relations and practices in health are structured by certain power/knowledge relations. This analysis reveals that there IX are many competing and complimentary power/knowledge relations that structure nursing, but that nursing, and in particular women's health nurses, also challenge the power/knowledge relations around them. Through examining theories of power and knowledge the analysis, argues that theoretical eclecticism is necessary to address the complex and varied nature of nursing work. In particular it identifies that postmodern and radical feminist theorising provide the most appropriate framework to further analyse and interpret the work of women's health nurses. Fundamental to the position argued in this thesis is a feminist perspective. This position creates important theoretical and methodological links throughout the whole study. Feminist methodology was employed to guide the design, the collection and the analysis. Intrinsic to this process was the use of the 'voices' of women's health nurses as the basis for theorising. The 'voices' of these nurses are highlighted in the chapters as italicised bold script. A constant companion along the way in examining women's health nurses' work, was the reflexivity with feminist research processes, the theoretical discussions and their 'voices'. Capturing and analysing descriptive accounts of nursing praxis is seen in this thesis as providing a way to theorise about nursing work. This methodology is able to demonstrate the knowledge forms embedded in clinical nursing praxis. Three conceptual threads emerge throughout the discussions: one focuses on nursing praxis as a distinct process, with its own distinct epistemological base rather than in relation to 'other' knowledge forms; another describes the medical restriction and opposition as experienced by this group of nurses, but also of their resistance to medical opposition. The third theme apparent from the interviews, and which was conceptualised as beyond resistance, was the description of the alternative discourses evident in nursing work, and this focused on notions of being a professional and on autonomous nursing praxis. This study concludes that rather than accepting the totalising discourses about nursing there are examples within nursing of resistance—both ideologically and X in practice—to these dominant discourses. Women's health nurses represent an important model of women's health service delivery, an analysis of which can contribute to critically reflecting on the 'paradigm of oppression' cited in nursing and about nursing more generally. Reflecting on women's health service delivery also has relevance in today's policy environment, where structural shifts in Commonwealth/State funding arrangements in community based care, may undermine women's health programs. In summary this study identifies three important propositions for nursing: • nursing praxis can reconstruct traditional models of health care; • nursing praxis is powerful and able to 'resist' dominant discourses; and • nursing praxis can be transformative. Joining feminist perspectives and alternative analyses of power provides a pluralistic and emancipatory politics for viewing, describing and analysing 'other' nursing work. At the micro sites of power and knowledge relations—in the everyday practice worlds of nurses, of negotiation and renegotiation, of work on the margins and at the centre—women's health nurses' praxis operates as a positive, productive and reconstructive force in health care.

The Sustainable Farm Families Project : changing attittudes to health

Introduction: Farm health and safety has historically focussed on strategies such as injury prevention, safety audits and fulfilling legislative responsibilities. However, farmer injuries mask deeper health issues including higher rates of cancer, suicides, cardiovascular disease and stress. The relationship between occupational health and safety and farm family health has not been fully investigated. The Sustainable Farm Families (SFF) project attempts to make this connection in order to address premature death, morbidity and injury on Australian farms. The SFF project illustrates how increasing health literacy through education and physical assessment can lead to improved health and knowledge outcomes for farm families.

Methods: The SFF project focuses on the human resource in the triple bottom line and is working with farmers, families, industry and universities to collaboratively assess and promote improvement in the health and wellbeing of farm families. Based on a model of extension that engages farm families as active learners where they commit to healthy living and safe working practices, the SFF project is proving to be an effective model for engaging communities in learning and change. Health education and information is delivered to farm men and women aged 18 to 75 years using a workshop format. Pre- and post-knowledge surveys, annual physical assessments and focus group discussions form the methodological context for the research over a three-year intervention.

Results: This article discusses the progress of the research outlining the design of the SFF project, the delivery and extension processes used to engage 321 farm families from within a broadacre and dairy-farming family sample. The article presents key learnings on intersectoral collaboration, engaging farmers and families in health, and the future for this project extending into agricultural industries across the nation. Key results reveal that health issues do exist in farming families and are often underreported by family members. Health indicators were at a level where referral and intervention was required in over 60% of men and 70% of women in both broad acre and dairy industries. Farm men and women verbalised health concerns relating to access, support and control mechanisms of the health system. Participants also revealed how they put into practice their new knowledge and how this has influenced their health.

Conclusions: The key learning is that farm men and women who are at high risk of premature morbidity and mortality will participate in health education and assessment programs based on industry collaboration with high levels of individual participation. This program provides evidence that farmers will engage with health professionals if programs are presented to them in personally engaging and relevant ways. The SFF program is a definite tool for interventional health promotion that supports attitudinal change to health and farming practices.

A grounded theory of intuition among occupational therapists in mental health practice

Objectives: This study aimed to explore occupational therapists’ understanding and use of intuition in mental health practice.
Method: Using a grounded theory approach, a theoretical sample of nine occupational therapists practising in mental health settings participated in semi-structured interviews. Data were analysed using the constant comparative method.
Findings: Intuition was found to be embedded within clinical reasoning. From the data, intuition was defined as knowledge without conscious awareness of reasoning. The participants viewed intuition as elusive and underground, and suggested that professional experience led to a more comfortable use of intuition. Using intuition relied on therapists’ understanding of their own and others’ emotions, and intuition partnered analysis within their clinical reasoning. A grounded theory of the use of intuition in mental health settings is proposed.
Conclusion: Occupational therapists practising in mental health settings understand intuition to be an instinctive understanding of situations, resulting from their professional experience and the understanding of emotions.

Scope of practice of occupational therapists working in Victorian community health settings

Background/aim: Current health policy places emphasis on community-based health care and it is expected that there will be an increase in the number of people receiving care in community settings. This study aimed to examine the profile and scope of practice of occupational therapists working in Victorian community health settings and the amount and type of health promotion activity incorporated into their role.
Method:  An anonymous postal questionnaire was sent to 205 community-based Victorian occupational therapists. One hundred and one (49.3% response rate) questionnaires were returned, with 72 respondents (35.1%) meeting study inclusion criteria. A descriptive research design was used to address study aims.
Results:  Results indicate that the majority of community health occupational therapists are experienced practitioners, have a varied scope of practice and report a high level of job satisfaction. Compared with previous studies, there is an increase in new graduate occupational therapists starting their career in community health settings, a greater number of part-time workers and a diversification of clinical and non-clinical roles. Barriers to practice that exist include high demand for service, limited funding and time spent on administrative tasks. Although health promotion was regarded as an important role of community health workers, a large number of therapists were not involved in this activity because of limited knowledge and clinical work taking priority.
Conclusion: Study findings have implications for occupational therapy training, and there is a clear need for input at policy level to address the significant resource allocation issues raised.

Relationship between intuition and emotional intelligence in occupational therapists in mental health practice

Objective: 
Clinical reasoning studies have acknowledged tacit aspects of practice, and recent research suggests that clinical reasoning contains intuition informed by tacit knowledge. Intuition also appears to be influenced by awareness and understanding of emotions. This study investigated the relationship between intuition and emotional intelligence among occupational therapists in mental health practice.

Policing services with mentally ill people : developing greater understanding and best practice

Although it is now well known that there is a disproportionate number of people with mental illnesses in the criminal justice system, surprising little attention has been paid to the challenges faced by policing people with mental illnesses in the community. This article provides an overview of some of the key findings from a programme of research undertaken in Victoria to further understand and develop a best practice model at this interface. The areas covered will include the prevalence of psychiatric symptoms and mental illnesses among police cell detainees; the existing knowledge base and attitudes of police towards mentally ill people; the relationship between mental illness and offending; the frequency and nature of police apprehensions of mentally ill people under the Mental Health Act; the association among mental disorder, police shootings, and other injuries to people as a result of these encounters; and police interactions with victims of crime. The work highlights the need for ongoing improvements in policing people with mental illnesses, and particularly the need for improved inter-agency practices for dealing with them.

Clinical research and leadership training program as a knowledge translation initiative across an Australian health care service

 Health professionals need to be integrated more effectively in clinical research initiatives to ensure that research addresses key clinical needs and provides practical, implementable solutions at the coal face of care. Here we describe the informative phase of a broader program to enable and support health professionals at Monash Health who do not have a research background, to engage in and lead research to improve healthcare outcomes. The findings will be used to develop a dedicated clinical research and leadership training program. The training program will support Monash Health staff to up-skill or enhance skills to conduct rigorous research; engage and lead multidisciplinary, collaborative teams; and to use research to guide practice, as well as identify and address gaps in clinical research.  

Bridging the copyright and licensing knowledge gap

Objectives: The purpose of this project was to examine the copyright and licensing knowledge gap of academic staff to identify their current understanding of, and attitudes towards, copyright, licensing and the open access movement in relation to the content they use, create, and share in their teaching and research practice. The motivation behind this study was to gather information to assist the Library in creating and providing effective information resources and training for academic staff.

Methods: An anonymous online survey was distributed to Faculty of Health academic staff at Deakin University. Seventy individuals in the Faculty of Health completed the survey.

Results: The results suggested that most of the academics have used content created by others in their teaching materials, but they are not confident about complying with copyright or licensing conditions whilst doing so. Most had not posted any of their own content online, but would generally be willing for it to be used by others, with attribution. Around half had never posted their published articles in an institutional or discipline repository, but again, would be willing for them to be used for educational purposes. Most academics have never shared their research data online, and some were very unwilling to do so - despite current pushes to broaden access to research data sets. Finally, most had never applied a Creative Commons licence to a piece of work, and over half were unaware of what rights they had retained under publishing agreements for their work. It was strongly indicated that an informational website would be very helpful in providing guidance around topics of copyright, licensing and sharing.

Conclusions: Results were largely consistent with other similar studies conducted around these topics. There is a clear role for librarians to continue providing such training and resources as the push for Open Access resources, publishing, and data only gains momentum.

Using patients' experiences of adverse events to improve health service delivery and practice: protocol of a data linkage study of Australian adults age 45 and above

Evidence of patients' experiences is fundamental to creating effective health policy and service responses, yet is missing from our knowledge of adverse events. This protocol describes explorative research redressing this significant deficit; investigating the experiences of a large cohort of recently hospitalised patients aged 45 years and above in hospitals in New South Wales (NSW), Australia.

Nurses' knowledge and attitudes regarding pain in Saudi Arabia

Unrelieved pain is a worldwide health care problem that can lead to unnecessary complications and increased health care expenditure. The aim of this study was to examine nurses' knowledge and attitudes toward pain in Saudi Arabia. A descriptive design was employed using the Nurses' Knowledge and Attitudes Survey regarding pain. The study took place in a tertiary teaching hospital in Saudi Arabia. All nurses employed in the hospital were eligible to participate. A total of 775 questionnaires were distributed to nurses working in acute care, intensive care, and nursing education and administration settings. In all, 593 respondents completed the questionnaires, representing a response rate of 76.5%. Data were analyzed using descriptive and inferential statistics. Most participants were from overseas (97.5%), speaking 23 different languages; 36.5% of nurses held a bachelors of science degree in nursing or the equivalent. The mean score of correctly answered items in was 16.9 (95% confidence interval, 16.6-17.31) out of a total possible score of 40. Nurses demonstrated some misconceived attitudes such as not giving the required dose of morphine to a smiling patient despite the patient being in pain. It is of concern that the findings identified problems of inadequate knowledge and inappropriate attitudes regarding pain assessment and management in Saudi Arabia. Considering these problems, the development of pain programs and policies affecting national and international nurses is highly imperative.

Psychometric properties of a tool to measure nurses' attitudes to single checking medications: SCAMS-II

BACKGROUND AND AIMS: Single checking medications has been increasingly adopted over the past decade by nurses in Australian healthcare services. However, attitudes toward the practice of only one nurse checking medications remain unclear. The aim of this article is to report on the development, reliability, and validity of a tool to measure nurses' attitudes to single checking medications in a health service in which single checking has been in place for over a decade. METHODS: In a cross-sectional survey design, the Single Checking and Administration of Medications Scale (SCAMS-II) was used to measure the attitudes of 299 registered nurses (RNs) who were single checking medications in one metropolitan teaching hospital in Australia. Exploratory factor analysis was used to explore the dimensions that best represented the SCAMS-II. Cronbach's α was used to assess internal consistency of the identified subscales. To test the construct validity of the emergent questionnaire, Confirmatory Factor Analysis and Rasch analyses were performed. RESULTS: The psychometric properties of the SCAMS-II revealed 12 items with three reliable subscales: a five-item accountability model; a four-item efficiency model; and a three-item knowledge model. LINKING EVIDENCE TO ACTION: In settings where single checking is current practice, the SCAMS-II is recommended as a reliable tool to measure nurses' attitudes toward the single checking of medications. The findings from this study may assist healthcare organizations in the development of policy and procedure guidelines for the safe administration of medications.

Identifying educational priorities for occupational therapy students to prepare for mental health practice in Australia and New Zealand: opinions of practising occupational therapists

BACKGROUND: The effective preparation of occupational therapy students for mental health practice is critical to facilitate positive consumer outcomes, underpin optimal practice and support new graduates' professional identity. This project was established to determine a set of 'educational priorities' for occupational therapy students to prepare them for current (and future) entry-level practice in mental health, from the perspective of mental health occupational therapists in Australia and New Zealand. METHODS: The study included two phases. In Phase One, participants identified what they considered to be important educational priorities for occupational therapy students to prepare them for practice in mental health. For Phase Two, an 'expert panel' was assembled to review and rank these using a Policy Delphi approach. RESULTS: Eighty-five participants provided educational priorities in Phase One. These were grouped into a total of 149 educational themes. In Phase Two, the expert panel (consisting of 37 occupational therapists from diverse locations and practice settings) prioritised these themes across three Delphi rounds. A final priority list was generated dividing educational themes into three prioritised categories: 29 'Essential', 25 'Important' and 44 'Optional' priorities. Highest-ranked priorities were: clinical reasoning, client-centred practice, therapeutic use of self, functional implications of mental illness, therapeutic use of occupation and mental health fieldwork experience. CONCLUSION: The priority list developed as part of this project provides additional information to support the review of occupational therapy curricula across Australia and New Zealand to ensure that new graduates are optimally prepared for mental health practice.

Health improvement and prevention study (HIPS) - evaluation of an intervention to prevent vascular disease in general practice

Background

The Health Improvement and Prevention Study (HIPS) study aims to evaluate the capacity of general practice to identify patients at high risk for developing vascular disease and to reduce their risk of vascular disease and diabetes through behavioural interventions delivered in general practice and by the local primary care organization.

Methods/Design

HIPS is a stratified randomized controlled trial involving 30 general practices in NSW, Australia. Practices are randomly allocated to an 'intervention' or 'control' group. General practitioners (GPs) and practice nurses (PNs) are offered training in lifestyle counselling and motivational interviewing as well as practice visits and patient educational resources. Patients enrolled in the trial present for a health check in which the GP and PN provide brief lifestyle counselling based on the 5As model (ask, assess, advise, assist, and arrange) and refer high risk patients to a diet education and physical activity program. The program consists of two individual visits with a dietician or exercise physiologist and four group sessions, after which patients are followed up by the GP or PN. In each practice 160 eligible patients aged between 40 and 64 years are invited to participate in the study, with the expectation that 40 will be eligible and willing to participate. Evaluation data collection consists of (1) a practice questionnaire, (2) GP and PN questionnaires to assess preventive care attitudes and practices, (3) patient questionnaire to assess self-reported lifestyle behaviours and readiness to change, (4) physical assessment including weight, height, body mass index (BMI), waist circumference and blood pressure, (5) a fasting blood test for glucose and lipids, (6) a clinical record audit, and (7) qualitative data collection. All measures are collected at baseline and 12 months except the patient questionnaire which is also collected at 6 months. Study outcomes before and after the intervention is compared between intervention and control groups after adjusting for baseline differences and clustering at the level of the practice.

Discussion

This study will provide evidence of the effectiveness of a primary care intervention to reduce the risk of cardiovascular disease and diabetes in general practice patients. It will inform current policies and programs designed to prevent these conditions in Australian primary health care.