Emergency health services : demand and service delivery models. Monograph 1: literature review and activity trends

Emergency Health Services (EHS), encompassing hospital-based Emergency Departments (ED) and pre-hospital ambulance services, are a significant and high profile component of Australia’s health care system and congestion of these, evidenced by physical overcrowding and prolonged waiting times, is causing considerable community and professional concern. This concern relates not only to Australia’s capacity to manage daily health emergencies but also the ability to respond to major incidents and disasters. EHS congestion is a result of the combined effects of increased demand for emergency care, increased complexity of acute health care, and blocked access to ongoing care (e.g. inpatient beds). Despite this conceptual understanding there is a lack of robust evidence to explain the factors driving increased demand, or how demand contributes to congestion, and therefore public policy responses have relied upon limited or unsound information. The Emergency Health Services Queensland (EHSQ) research program proposes to determine the factors influencing the growing demand for emergency health care and to establish options for alternative service provision that may safely meet patient’s needs. The EHSQ study is funded by the Australian Research Council (ARC) through its Linkage Program and is supported financially by the Queensland Ambulance Service (QAS). This monograph is part of a suite of publications based on the research findings that examines the existing literature, and current operational context. Literature was sourced using standard search approaches and a range of databases as well as a selection of articles cited in the reviewed literature. Public sources including the Australian Institute of Health and Welfare (AIHW), the Council of Ambulance Authorities (CAA) Annual Reports, Australian Bureau of Statistics (ABS) and Department of Health and Ageing (DoHA) were examined for trend data across Australia.

YouTube

Originally launched in 2005 with a focus on user-generated content, YouTube has become the dominant platform for online video worldwide, and an important location for some of the most significant trends and controversies in the contemporary new-media environment. Throughout its very short history, it has also intersected with and been the focus of scholarly debates related to the politics, economics, and cultures of the new media—in particular, the “participatory turn” associated with “Web 2.0” business models’ partial reliance on amateur content and social networking. Given the slow pace of traditional scholarly publishing, the body of media and cultural studies literature substantively dedicated to describing and critically understanding YouTube’s texts, practices, and politics is still small, but it is growing steadily. At the same time, since its inception scholars from a wide range of disciplines and critical perspectives have found YouTube useful as a source of examples and case studies, some of which are included here; others have experimented directly with the scholarly and educational potential of the platform itself. For these reasons, although primarily based around the traditional publishing outlets for media, Internet, and cultural studies, this bibliography draws eclectically on a wide range of sources—including sources very closely associated with the web business literature and with the YouTube community itself.

The development and evaluation of a culturally affirmative counselling model for deaf clients in Australia

In Australia, there is only one, newly established, dedicated mental health service catering specifically for the signing *Deaf community. It is staffed by four part-time hearing professionals and based in Brisbane. There are currently no Deaf psychologists or psychiatrists and there is no valid or reliable empirical evidence on outcomes for Deaf people accessing specialised or mainstream mental health services. Further compounding these issues, is the fact that there are no sign language versions of the most common standardised mental health or psychological instruments available to clinicians in Australia. Contemporary counselling literature is acknowledging the role of the therapeutic alliance and the impact of 'common factors' on therapeutic outcomes. However, these issues are complicated by the relationship between the Deaf client and the hearing therapist being a cross-cultural exchange. The disability model of deafness is contentious and few professionals in Australia have the requisite knowledge and understanding of deafness from a cultural perspective to attend to the therapeutic relationship with this in mind. Consequently, Deaf people are severely disadvantaged by the current lack of services, resources and skilled professionals in the field of deafness and psychology in this country. The primary aim of the following program of research has been to propose a model for culturally affirmative service delivery and to provide clinicians with tools to evaluate the effect of their therapeutic work with Deaf people seeking mental health treatment. The research document is presented as a thesis by publication and comprises four specific objectives formulated in response to the lack of existing services and resources. The first objective was to explore the use of social constructionist counselling techniques and a reflecting team with Deaf clients, hearing therapists and an interpreter. Following the establishment of a pilot counselling clinic, indepth semi-structured interviews were conducted with two long-term clients following the one year pilot of this service. These interviews generated recommendations for the development of a new 'enriched' model of counselling to be implemented and evaluated in later stages of the research program. The second objective was to identify appropriate psychometric measures that could be translated into Australian Sign Language (Auslan) for research into efficacy, effectiveness and counselling outcomes. Two instruments were identified as potentially suitable; the Outcome Rating Scale (ORS), a measure of global functioning, and the Session Rating Scale (SRS), a measure of therapeutic alliance. A specialised team of bi-lingual and bi-cultural interpreters, native signers and the primary researcher for this thesis, produced the ORS-Auslan and the SRS-Auslan in DVD format, using the translation and back-translation process. The third objective was to establish the validity and reliability of these new Auslan measures based on normative data from the Deaf community. Data from the ORS-Auslan was collected from one clinical and one non-clinical sample of Deaf people. Statistical analyses revealed that the ORS-Auslan is reliable, valid and adequately distinguishes between clinical and non-clinical presentations. Furthermore, construct validity has been established using a yet to be validated sign language version of the Depression, Anxiety and Stress Scale-21 items (DASS-21), providing a platform for further research using the DASS-21 with Deaf people. The fourth objective was to evaluate counselling outcomes following the implementation of an enriched counselling service, based on the findings generated by the first objective, and using the newly translated Auslan measures. A second university counselling clinic was established and implemented over the course of one year. Practice-based evidence guided the research and the ORS-Auslan and the SRS-Auslan were administered at every session and provided outcome data on Deaf clients' global functioning. Data from six clients over the course of ten months indicated that this culturally affirmative model was an effective approach for these six clients. This is the first time that outcome data have been collected in Australia using valid and reliable Auslan measures to establish preliminary evidence for the effectiveness of any therapeutic intervention for clinical work with adult, signing Deaf clients. The research generated by this thesis contributes theoretical knowledge, professional development and practical resources that can be used by a variety of mental health clinicians in the context of mental health service delivery to Deaf clients in Australia.

Part-time job design : symptom and solution for a changing work environment

Part-time work presents a conundrum. Across industrialised countries, there has been significant growth in part-time work as a solution to resolving the diverse interests of employers, workers and families in managing time and resources. However, there are intrinsic disadvantages associated with part-time work; notably with pay and career prospects, which impact the same stakeholders it is intended to benefit. These disadvantages are particularly evident in professional services organisations, due to strong cultural norms of long work hours, single-focused commitment to work and 24x7 availability. There are indications, both in research and practice, that the design of part-time work arrangements could be improved to address some of the disadvantages associated with part-time work, and to challenge norms and dated assumptions that influence the structure of professional work. This study explored the changes made when professional service workers move from a full-time to part-time arrangement. The study drew on a recently proposed framework for work design, which extended previous models to reflect substantial changes in the contemporary work environment. The framework proved to be a useful perspective from which to explore the design of part-time work, principally because it integrated previously disconnected areas of literature and practice through a broader focus on the context of work. Exploration of the differences between part-time and full-time roles, and comparisons between part-time roles in similar types of work, provided insights into the design of professional part-time work. Analysis revealed that having a better understanding of design characteristics may help explain disadvantages associated with professional part-time work, and that some full-time roles can be more easily adapted to part-time arrangements than others. Importantly, comparisons revealed that even roles that are considered difficult to undertake on a part-time basis can potentially be re-designed to be more effective. Through empirical testing of the framework, a contextualised work design model is presented that may guide further research and the practice of crafting part-time arrangements. The findings also suggest that poor work design may lead to the symptoms associated with professional part-time work, and that improved work design may be a potential solution to these structural constraints.

An investigation of unique challenges in National Historic relics and scenic sites (NHRSSs) in Chinese research literature 1982-2008 using co-word analysis

National Housing Relics and Scenic Sites (NHRSSs) in China are the equivalent of National Parks in the West but have contrasting features and broader roles when compared to their Western counterparts. By reviewing and analysing more than 370 academic sources, this paper identifies 6 major issue clusters and future challenges that will influence the management of NHRSSs over time. It also provides a number of cases to illustrate the particular features of NHRSSs. Identifying the hot issues and important challenges in Chinese NHRSSs will provide valuable insights into priorities now being discussed in highly populated areas of the World.

Parsing the Australian curriculum English : grammar, multimodality and cross-cultural texts

The release of the Australian Curriculum English (ACE) by the Australian Curriculum, Assessment and Reporting Authority (ACARA) has revived debates about the role of grammar as English content knowledge. We consider some of the discussion circulating in the mainstream media vis-à-vis the intent of the ACE. We conclude that this curriculum draws upon the complementary tenets of traditional Latin-based grammar and systemic functional linguistics across the three strands of Language, Literature and Literacy in innovative ways. We argue that such an approach is necessary for working with contemporary multimodal and cross-cultural texts. To demonstrate the utility of this new approach, we draw out a set of learning outcomes from Year 6 and then map out a framework for relating the outcomes to the form and function of multimodal language. As a case in point, our analysis is of two online Coca-Cola advertising texts, one each from South Korea and Australia.

Capstones : transitions and professional identity

The literature identifies transition as a key objective for capstone experiences. Capstones should take account of the particular needs of final year students by assisting them to transition from their student to their professional identity. The authors are currently completing an Australian Learning and Teaching Council (ALTC) funded project, “Curriculum Renewal in Legal Education: articulating final year curriculum design principles and a final year program”, which seeks to achieve curriculum renewal for legal education in the Australian context through the articulation of a set of curriculum design principles for the final year and the design of a transferable model for an effective final year program. The project has investigated the contemporary role of capstones in assisting transition out by reviewing the relevant literature and considering feedback from a project reference group, a final year student focus group and a recent graduate’s focus group. Analysis of this extensive research- and evidence-base suggests that capstone experiences should support transition through: • Assisting students to develop a sense of professional identity; • Consolidating students’ lifelong learning skills; • Providing opportunities for consolidation of career development and planning processes; • Enabling students to enhance professional skills and competencies; and • Preparing students as ethical citizens and leaders. This paper will examine the role of capstones in assisting students to transition to their professional identity and will propose learning and teaching approaches and assessment of learning methods that support transition out.

Why do nurses migrate? – a review of recent literature

Aim  To identify the reasons why nurses continue migrating across international borders. Background  International nurse recruitment and migration have been increasing in the last decade and recent trends show an increase in the movement of nurses between developing and developed countries, resulting in a worldwide shortage of nurses. Methods  A manual and electronic database literature search was conducted from January 2004 to May 2010. Qualitative content analysis was completed for the final 17 articles that satisfied the inclusion criteria. Results  Motivators to nurse migration were linked to financial, professional, political, social and personal factors. Although economic factors were the most commonly reported, they were not the only reason for migration. This was especially evident among nurses migrating between developed countries. Conclusion  Nurses migrate for a wide variety of reasons as they respond to push and pull factors. Implications for nursing management  It is important for nurse managers in the source countries to advocate incentives to retain nurses. In the recipient countries the number of international nurses continues to increase implying the need for more innovative ways to mentor and orientate these nurses.

Contemporary public health policy

- identify the terms policy, public policy and health policy, the stages of policy development and the role that values and politics play in policymaking - recognise contemporary international developments in public health and their impact on national policymaking and the health of Australians - describe the basic structure and financing of Australia’s health system and the role of public health within it - identify Australia’s national public health priorities, and be able to critique the development of the National Chronic Disease Strategy, as an example.

Teaching and Learning in Maritime Security: A Literature Review

With the rise in attacks and attempted attacks on marine‐based critical infrastructure, maritime security is an issue of increasing importance worldwide. However, there are three significant shortfalls in the efforts to overcome potential threats to maritime security: the need for greater understanding of whether current standards of best practice are truly successful in combating and reducing the risks of terrorism and other security issues, the absence of a collective maritime security best practice framework and the need for improved access to maritime security specific graduate and postgraduate (long) courses. This paper presents an overview of existing international, regional national standards of best practice and shows that literature concerning the measurement and/ or success of standards is virtually non‐existent. In addition, despite the importance of maritime workers to ensuring the safety of marine based critical infrastructure, a similar review of available Australian education courses shows a considerable lack of availability of maritime security‐specific courses other than short courses that cover only basic security matters. We argue that the absence of an Australian best practice framework informed by evaluation of current policy responses – particularly in the post 9/11 environment – leaves Australia vulnerable to maritime security threats. As this paper shows, the reality is that despite the security measures put in place post 9/11, there is still considerable work to be done to ensure Australia is equipped to overcome the threats posed to maritime security.

Trends in policies, programs and practices in the Australasian First Year Experience literature 2000-2010. The First Year in Higher Education Research Series on Evidence-based Practice. Number 1

This publication is the first in a series of scholarly reports on research-based practice related to the First Year Experience in Higher Education. This report synthesises evidence about practice-based initiatives and pragmatic approaches in Aotearoa (New Zealand) and Australia that aim to enhance the experience of commencing students in the higher education sector. Trends in policies, programs and practices ... examines the first year experience literature from 2000-2010. It acknowledges the uniqueness of the Australasian socio-political context and its influence on the interests and output of researchers. The review surveyed almost 400 empirical reports and conceptual discussions produced over the decade that dealt with the stakeholders, institutions and the higher education sector in Australasia. The literature is examined through two theoretical constructs or “lenses”: first, a set of first year curriculum design principles and second, the generational approach to describing the maturation of initiatives. These outcomes and suggested directions for further research provide the challenges and the opportunities for FYE adherents, both scholars and practitioners, to grapple with in the next decade.

The impact of knowledge integration on enterprise system success

Despite promising benefits and advantages, there are reports of failures and low realisation of benefits in Enterprise System (ES) initiatives. Among the research on the factors that influence ES success, there is a dearth of studies on the knowledge implications of multiple end-user groups using the same ES application. An ES facilitates the work of several user groups, ranging from strategic management, management, to operational staff, all using the same system for multiple objectives. Given the fundamental characteristics of ES – integration of modules, business process views, and aspects of information transparency – it is necessary that all frequent end-users share a reasonable amount of common knowledge and integrate their knowledge to yield new knowledge. Recent literature on ES implementation highlights the importance of Knowledge Integration (KI) for implementation success. Unfortunately, the importance of KI is often overlooked and little about the role of KI in ES success is known. Many organisations do not achieve the potential benefits from their ES investment because they do not consider the need or their ability to integrate their employees’ knowledge. This study is designed to improve our understanding of the influence of KI among ES end-users on operational ES success. The three objectives of the study are: (I) to identify and validate the antecedents of KI effectiveness, (II) to investigate the impact of KI effectiveness on the goodness of individuals’ ES-knowledge base, and (III) to examine the impact of the goodness of individuals’ ES-knowledge base on the operational ES success. For this purpose, we employ the KI factors identified by Grant (1996) and an IS-impact measurement model from the work of Gable et al. (2008) to examine ES success. The study derives its findings from data gathered from six Malaysian companies in order to obtain the three-fold goal of this thesis as outlined above. The relationships between the antecedents of KI effectiveness and its consequences are tested using 188 responses to a survey representing the views of management and operational employment cohorts. Using statistical methods, we confirm three antecedents of KI effectiveness and the consequences of the antecedents on ES success are validated. The findings demonstrate a statistically positive impact of KI effectiveness of ES success, with KI effectiveness contributing to almost one-third of ES success. This research makes a number of contributions to the understanding of the influence of KI on ES success. First, based on the empirical work using a complete nomological net model, the role of KI effectiveness on ES success is evidenced. Second, the model provides a theoretical lens for a more comprehensive understanding of the impact of KI on the level of ES success. Third, restructuring the dimensions of the knowledge-based theory to fit the context of ES extends its applicability and generalisability to contemporary Information Systems. Fourth, the study develops and validates measures for the antecedents of KI effectiveness. Fifth, the study demonstrates the statistically significant positive influence of the goodness of KI on ES success. From a practical viewpoint, this study emphasises the importance of KI effectiveness as a direct antecedent of ES success. Practical lessons can be drawn from the work done in this study to empirically identify the critical factors among the antecedents of KI effectiveness that should be given attention.

Success and failure factors of shared services : an IS literature analysis

Organizations seeking improvements in their performance are increasingly exploring alternative models and approaches for providing support services; one such approach being Shared Services. Because of the possible consequential impact of Shared Services on organizations, and given that information systems (IS) is both an enabler of Shared Services (for other functional areas) as well as a promising area for Shared Services application, Shared Services is an important area for research in the IS field. Though Shared Services has been extensively adopted on the promise of economies of scale and scope, factors of Shared Services success (or failure) have received little research attention. This paper reports the distillation of success and failure factors of Shared Services from an IS perspective. Employing NVIVO and content analysis of 158 selected articles, 9 key success factors and 5 failure factors are identified, suggesting important implications for practice and further research.

Cohabitation : placing disability centre stage

The play Cohabitation places disability centre stage by creating a three dimensional protagonist who is also a wheelchair user. The accompanying exegesis examines the challenges associated with creating such a character for theatre, using a practice-led methodology. During the process of writing my case study play, I have investigated the international literature, reflected on my experience as a physician specialising in rehabilitation and collaborated with members of the Australian and international disability communities. I have also reflected on the historical stereotypes associated with disability and integrated the contemporary experience of wheelchair users into my script. By organising a production of the play in Australia and directing a rehearsed reading of the play in New York, I was able to scrutinise my additional goal of casting an actor who was also a wheelchair user. My research illuminates the issues involved in writing and producing a play in which the lead character also has a physical disability, and I would hope, offers insight into the creation of such a character and script.