The nature and implications of support in graduate nurse transition programs : an Australian study

It is widely recognized that support is critical to graduate nurse transition from novice to advanced beginner-level practitioner and to the integration of neophyte practitioners into safe and effective organizational processes. Just what constitutes support, however, and why (if at all) support is important, when, ideally, support should be given, by whom, how, and for how long, have not been systematically investigated. Building on the findings (previously reported) of a yearlong study that had, as its focus, an exploration and description of processes influencing the successful integration of new graduate nurses into safe and effective organizational processes and systems, the findings presented in this article strongly suggest that support is critical to the process of graduate nurse transition, and that integration into “the system” is best provided during the first 4 weeks of a graduate nurse transition program and thereafter at the beginning of each ward rotation; that “informal teachers” and the graduate nurses themselves are often the best sources of support; and that the most potent barriers to support being provided are the untoward attitudes of staff toward new graduates. Drawing on the overall findings of the study, a new operational definition of support is proposed and recommendations are made for future comparative research on the issue.

Designing effective training programs for investigative interviewers of children

'Best-practice' guidelines for conducting investigative interviews with children are well established in the literature, yet few investigative interviewers actually adhere to such guidelines in the field. One of the problems is that little discussion has focused on how such guidelines are learned and sustained by professionals. To address this concern, the current article reviews the key elements of interview training programs that are known to promote competent interviewing. These elements include: (i) the establishment of key principles or beliefs that underpin effective interviewing, (ii) the adoption of an interview framework that maximises narrative detail, (iii) clear instruction in relation to the application of the interview framework, (iv) effective ongoing practice, (v) expert feedback and (vi) regular evaluation of interviewer performance. A description and justification of each element is provided, followed by broad recommendations regarding how these elements can be implemented by police and human service organisations in a cost-effective manner.

Weight concerns among elementary school children : a review of prevention programs

There is increasing evidence that children display high levels of weight and muscle concerns, which include body dissatisfaction and problem eating. In order to address these issues, researchers have designed and implemented prevention programs for this age group. Thirteen published studies were located and reviewed, with children aged 8–12 years from elementary schools, or equivalent. Overall, the programs were shown to be effective in improving children's knowledge at post-test and at follow-up assessments. However, there is limited evidence to show that the programs reduced or prevented body image concerns and/or problem eating. Too few studies have examined muscle concerns so no conclusions can yet be drawn about this domain. Limitations of the studies and suggestions for future prevention efforts are discussed.

The influence of strategic HRM and sector on perceived performance in health services organizations

In this study, we examine a variety of management characteristics of for-profit and not-for-profit organizations in the health services (HS) industry. Data collected from Australian senior executives are used to test the relationships between managerial constructs such as employee commitment, customer demandingness, strategic HRM orientation and the adoption of human capital-enhancing human resource (HR) practices and perceived overall performance. Data analysis conducted using the Partial Least Square Modeling show a statistically significant path from commitment to employees, customer demandingness and strategic HRM orientation to the adoption of human capital-enhancing HR practices (such as selective staffing, comprehensive training, and performance appraisal) to perceived organizational performance. The results also show that private sector health service organizations have a higher level of perceived performance.

Exploring the barriers and enablers to attendance at rural cardiac rehabilitation programs

Objective: The objectives of this study were to: (i) identify local barriers and enablers to the uptake of hospital-based cardiac rehabilitation (CR) programs, and (ii) identify preferred alternatives for the delivery of CR.

Design: A questionnaire administered by local CR coordinators and focus groups facilitated by the research team.

Setting: Six regional hospitals in south-west Victoria offering hospital-based CR programs.

Participants: Patients and their carers referred to and eligible for local CR programs; health professionals working within local CR programs.

Main outcomes measures: CR attendees and decliners demographics, patient and health professional perceived factors which contribute to enabling hospital-based CR attendance, patient and health professional perceived barriers to CR attendance, and receptiveness and preferences for alternative modes of CR delivery.

Results: This study identified distance to travel to hospital-based CR programs the only statistically significant factor in determining uptake of CR. Easy access to transport (63%) and to a lesser extent family support (49%) and work flexibility (43%) were the primary enablers to attendance. Of the 97 study participants, 38% were receptive to alternative CR methods such as programs in outlying communities, evening facility-based programs, home and GP based programs, telephone support and a patient manual/workbook.

Conclusions: The results of this study provide valuable information for designing strategies to increase utilisation and improve patient acceptability of existing hospital-based CR programs. It provides a basis for pilot testing alternative modes of CR program delivery for cardiac patients in rural areas unable to access hospital-based CR.

Investigation of stakeholders commitment to information security awaremess programs

Organisations have become increasingly dependent on technology in order to compete in their respective markets. As IT technology advances at a rapid pace, so does its complexity, giving rise to new IT security vulnerabilities and methods of attack. Even though the human factors have been recognized to have a crucial role in information security management, the effects of weakness of will and lack of commitment on the stakeholders (i.e., employers and employees) parts has never been factored into the design and delivery of awareness programs. To this end, this paper investigates the impacts of the availability of awareness programs and end-user drive and lack of commitment to information security awareness program design, delivery and success.

Developing recreation programs for disadvantaged sectors of the community

Physical activity participation can provide benefits for both the health and well-being of the community. Many people, however, are not active enough to achieve these health and well-being outcomes. The Victorian Health Promotion Foundation’s (VicHealth) 2001 Active Recreation Scheme funded 27 projects designed to provide recreation programs to address the active recreation needs of disadvantaged groups who are often the least physically active members of Victorian communities. This research aimed to identify themes and strategies of these projects that increased participation or reduced barriers to participation in active recreation. Site visit interviews were conducted with representatives of 11 projects to become familiar with successful program strategies and barriers to recreation program development. Following the site visits a focus group discussion with representatives from all 27 funded projects was conducted to explore ways in which barriers to recreation participation could be minimized and what strategies were effective in increasing recreation participation. Nine general dimensions that were identified as strategic approaches to increase the participation of disadvantaged groups in recreation programs were relationships, resources, community values/attitudes, communication (promotion and education), participant awareness/motivation, autonomy supportive, planning, program design, and mentors/role models. It was found that a focus on a community coalitions and complementary policy developments had positive effects on creating active communities. Four themes that guided the community and policy developments were i) community partnerships, ii) community support, iii) focus on the participants and iv) program design elements. The study also showed that the management and manipulation of these themes assisted agencies to develop programs that increased recreation participation.

Change of perspective: a measurable and desired outcome of chronic disease self-management intervention programs that violates the premise of preintervention/postintervention assessment

Objective: To determine if participants in chronic disease self-management courses have a change of perspective of their health status (a response shift), and if this is measurable with a paper-based questionnaire.

Methods: Nine items were developed to measure potential benefits of self-management courses. These were based on the constructs of a previous questionnaire, the Health Education Impact Questionnaire (HEI-Q). Cognitive interviews elicited spontaneous statements about the reasons for paper-based answers. Sensitivity, specificity, and overall accuracy of items were calculated using the interview as a relative gold standard. Response shift can be negative (i.e., after the course, participants realize that, before the course, they were worse than they thought they were), positive (i.e., participants now realize they were better than they thought they were), or absent (no change).

Results: Interviews (n = 39) reflected that true response shift occurred in approximately half the replies to questionnaire items. Of these, 31% were negative response shift, 20% were positive response shift. Response shift was absent in 32% of replies. Presence or absence of response shift could not be determined in 17% of replies across items. Significant concordance between questionnaires and cognitive interviews (average overall accuracy 0.79) indicated that the HEI-Q Perspective questionnaire detects response shift in participants of self-management courses. The questionnaire revealed that 87% of participants had response shift in at least 1 item.

Conclusion: This study suggests that preintervention/postintervention assessments of interventions such as self-management courses are confounded by a change in perspective of a large proportion of respondents. It also indicates response shift is a valuable outcome of self-management courses that can be measured with a paper-based questionnaire.

Investigating the factors of professional development programs that effect change in the classroom

This paper reports on the implementation of two professional development programs designed to support ICT based pedagogies in Victorian (Australia) schools. In both programs the teachers participated in an intensive program of professional development designed to assist them in embedding ICT into their classroom practice. There was a large diversity of circumstances experienced by the schools, not only in terms of ICT availability and use, and teacher experience, but also in issues of cultures of curriculum planning and integration, size, communication, and pedagogical presumptions. Both projects were successful in implementing change; however there were teachers in both projects who failed to take advantage of the PD. Some of the limitations with both studies include the high expectations of time comittment by the teachers – who are already fully committed with full teaching loads, and the high expectations of the change that will occur in the teaching and
learning as a result of the PD, wthout consideration of the time needed to learn and adopt new pedagogical practice. In some cases, teachers and the school did not appreciate the necessary commitment to take full advantage of the opportunity being provided. This was compounded by the lack of support and recognition by school management.

Chronic disease self-management education programs: challenges ahead

♦ Chronic disease self-management education programs aim to empower patients through providing information and teaching skills and techniques to improve self-care and doctor–patient interaction, with the ultimate goal of improving quality of life.

♦ The recent 2006–07 federal budget allocated an unprecedented $515 million over 5 years for activation of patient self-management activities, commencing this financial year.

♦ Previous attempts in other countries to incorporate self-management education activities into the health care sector have faced setbacks because of inadequate integration into primary care.

♦ Engagement of health care professionals and their endorsement of self-management activities is critical to success.

Are youth mentoring programs good value-for-money? An evaluation of the Big Brothers Big Sisters Melbourne program

Background : The Big Brothers Big Sisters (BBBS) program matches vulnerable young people with a trained, supervised adult volunteer as mentor. The young people are typically seriously disadvantaged, with multiple psychosocial problems.

Methods : Threshold analysis was undertaken to determine whether investment in the program was a worthwhile use of limited public funds. The potential cost savings were based on US estimates of life-time costs associated with high-risk youth who drop out-of-school and become adult criminals. The intervention was modelled for children aged 10–14 years residing in Melbourne in 2004.

Results : If the program serviced 2,208 of the most vulnerable young people, it would cost AUD 39.5 M. Assuming 50% were high-risk, the associated costs of their adult criminality would be AUD 3.3 billion. To break even, the program would need to avert high-risk behaviours in only 1.3% (14/1,104) of participants.

Conclusion : This indicative evaluation suggests that the BBBS program represents excellent 'value for money'.

Pilot study of an innovative model for clinical education in dietetics

Aim: To pilot and evaluate a new model of clinical dietetics education to address the sustainability of dietetic placements in the clinical setting.

Methods: Final-year dietetics students (n = 14) completed all nine weeks of clinical placement in the pilot program at two large tertiary referral and teaching health services in metropolitan Melbourne. Staff and students completed surveys about their experience within a week of completing placement. Data collected included paid and unpaid staff working hours, hours in clinical and teaching activity, hours of student attendance and student clinical work hours. Data for the last month of the placement programs in the preceding three years were used for comparison with the pilot program.

Results: Combined data for the two providers showed that the model reduced the amount of supervision hours per student hour on placement by 16% while maintaining quality indicators during the pilot compared with previous years. Students in the pilot program were more positive about their experience compared with students in the existing program. The overall trend of responses in the staff surveys was positive for the pilot program, but the trend was not as marked as that of student responses.

Conclusion: The new model of clinical dietetics education was successfully piloted and demonstrated the potential to increase student training capacity without a negative impact on student achievement or major resource demands. Refinements to the model and opportunities to enhance integration into the dietetics degree program were identified during the project. The learning needs of non-English-speaking background students require further scrutiny.

Programs for men who perpetrate domestic violence : an examination of the issues underlying the effectiveness of intervention programs

This review paper seeks to explore some of the reasons why rehabilitation programs for male perpetrators of domestic violence appear to be less effective in reducing recidivism than programs for other offender groups. It is argued that while the model of systems response to domestic violence has predominated at the inter-agency level, further consideration might be given to way in which men’s intervention groups are both designed and delivered. It is concluded that the program logic of men’s domestic violence programs is rarely articulated leading to low levels of program integrity, and that one way to further improve program effectiveness is to incorporate some of the approaches evident in more general violence prevention programs and from what is know about good practice in general about offender rehabilitation.

The meaning of anger for Australian Indigenous offenders : the significance of context

The problem of overrepresentation of Indigenous offenders in Australian prisons highlights the need for effective tertiary intervention programs within correctional settings as a way of reducing Indigenous reincarceration. This study seeks to explore meanings of anger within an Indigenous context that might inform the development of more acceptable and potentially more effective rehabilitation programs. A methodology that acknowledges the importance of narrative, context, and culture was devised to explore how anger as an emotion is understood and experienced by a group of Indigenous men in a South Australian prison. Although some of the major themes reflected experiences of anger common to many offenders, it was evident that for these Indigenous men, anger was experienced within a broad social and political context that imbued the experience of anger with layers of culturally specific meaning. It is suggested that these layers of meaning constitute sufficient difference to warrant further exploration.