Factors influencing the impact of secondary exposure to trauma

The research found significant relationships between secondary exposure to client trauma and symptoms associated with secondary traumatic stress and vicarious trauma in a sample of community mental health clinicians. The research supports developmental conceptualisations of the relationships between these constructs and burnout, and identifies potential individual vulnerability and protective factors. The portfolio explores the impact of childhood maltreatment from an attachment theory perspective. Four clinical cases are presented illustrating the clinical relevance of the impact of childhood maltreatment and attachment disturbance, and the complexities associated with current attachment classification systems and differential diagnosis.

Reflective positioning : the impact of conversations in the social and cultural environment of midwifery practice settings on professional learning for students

Literature reviews on the topic of reflection and reflective practice encompassed midwifery, nursing, medicine, allied health, education and professional education. This investigation also included socio-psychological theories by leading authors such as Benner (nursing), Sch&ouml;n (professional education) and positioning theory by Harr&eacute; and others. Positioning is a psycho-sociological ontology in which individuals metaphorically position themselves within three entities: people, institutions, and societies, where conversations are constructed and make an impact upon the social world. The social and cultural structures and interactions developed in Archer&rsquo;s morphogenesis were examined in terms of the impact of possible encounters and the transformational effects of learning experiences in practice settings. These bodies of work provided the theoretical framework for the author&rsquo;s research of students&rsquo; experiences in midwifery education for postgraduate students from which selected excerpts with three participating students and their supervising midwives are presented. These excerpts are related to reflective practices and the professional conversations conducted between students and midwives. It was found that reflective positioning applied in midwifery education by students can serve as an analytical tool in explaining social and cultural elements of clinical placements to influence and transform their learning. The potency of conversations that occur in everyday moment-to-moment interactions do contribute to students&rsquo; induction in professional midwifery practice and their identity formation as a midwife.<br />

The development of an accreditation scheme for accredited exercise physiologists

<b>Background: </b>Accredited Exercise Physiologists provide exercise services for people living with chronic disease, disability or injury and are recognised in Australia as Accredited Exercise Physiologists (AEP) under a national certification system administered by Exercise and Sport Science Australia (ESSA). A major breakthrough occurred for the AEP in 2006 when the Australian Department of Health and Ageing approved the AEP to deliver clinical exercise services for people with chronic medical conditions under the taxpayer-funded national health scheme, Medicare Australia. <br /><br /><b>Aims:</b> In light of these developments, the authors recognised the need for new accreditation criteria, and our report summarises the work that we did on behalf of the profession and ESSA in restructuring the accreditation system. <br /><br /><b>Methods and Outcomes: </b>We first performed a background study that defined the scope of practice of the AEP and benchmarked the AEP against other allied health professions in Australia and Clinical Exercise Physiologists internationally. We then constructed a new set of accreditation criteria comprising sets of pathologyspecific knowledge and experiences, together with a set of generic standards including communication, professional behaviour and risk management. All participating Australian universities (18 out of 27 responded) and 29 practitioner experts were then invited to provide comment and input into the draft guidelines. There was strong support for the new system that was implemented nationally on 1 January 2008 and is now administered by ESSA. <br /><br /><b>Conclusions: </b>This work has stimulated an unprecedented level of activity in the Australian university sector in developing new curricula in clinical exercise science and practice, and is intended to lead to improved standards of clinical exercise practice.<br />

Accreditation down under

The article reports on the recognition given by the Department of Health and Ageing in Australia on the entry of the accredited exercise physiologist (AEP) into the field of allied health. It mentions that the recognition permits general practitioners (GPs) to refer patients directly to AEPs for clinical exercise services under Medicare Australia. It notes that the development enables the national health system to finance clinical exercise services rendered by exercise professionals like AEPs.<br />

MAAGs: the next generation. A study of the development of medical audit advisory groups and the arrangements for supporting clinical audit in primary care

<b>Background: </b>MAAGs have, historically, been disparate organisations with a lack of central direction, albeit with the same goal: to develop and support the performance of audit in primary care. This goal has been (and is being) achieved in a number of ways all over the country. In the last two years, MAAGs have witnessed many changes in primary care and are adapting themselves to suit these new arrangements at a local level. <br /><br /><b>Aim: </b>To formalise our knowledge of where MAAGs are going, how they are getting there and the support they are receiving. <br /><br /><b>Method: </b>A postal questionnaire to the 104 MAAGs in England and Wales, addressing 6 main issues of relevance to the development of MAAGs and the support they are receiving. <br /><br /><b>Results:</b> At least two MAAGs have dissolved, leaving a possible total of 102 still in existence. Of these, 76 (74.5%) responded to the survey. The composition of the MAAG committee has changed dramatically since the inception of MAAGs in 1990, and staffing levels appear to have risen substantially. MAAGs appear to be more adequately funded by their health authorities than has previously been reported and many are actively seeking additional sources of funding. There is still large variation in levels of MAAG funding. Furthermore, funding is unrelated to the number of GPs or practices served. Security for MAAG staff appears to have been addressed in many areas, with 84% of MAAGs having at least one member of staff on a permanent employment contract. Many MAAGs are developing rolling programmes in an attempt to eliminate the short-sighted approach to the development of clinical audit that has existed since MAAGs were first set up. <br /><b><br />Conclusion:</b> Many MAAGs (with the obvious exception of those that have been dissolved) appear to be thriving without central direction or initiative. It is now evident that we were a little hasty in our concerns for the future of MAAGs beyond April 1996. It would seem that many organisations have taken the situation which arose two years ago as an opportunity to grow and develop in ways that may not have been possible within the confines of the Health Circular.<br />

Promoting "critical awareness" and critiquing "cultural competence" : towards disrupting received professional knowledges

There is a compelling argument that universities should be committed to advancing the Indigenous agenda. With respect to social work, as well as to nursing, psychology, and allied health, this commitment is often translated into a single goal: that graduates should be &lsquo;&lsquo;culturally competent&rsquo;&rsquo;. While acknowledging that there can be tactical advantages in pursuing this goal the current paper develops a practical critique of the expectation that cultural competence is an unproblematic &lsquo;&lsquo;add on&rsquo;&rsquo; to professional education. Using a single case study as an example*how the subject &lsquo;&lsquo;individual development&rsquo;&rsquo; is transmitted as a monocultural and unproblematic formation*we argue that it is impossible to learn to work cross-culturally without developing a capacity for reflective self-scrutiny. Less likely to be a flag of convenience than &lsquo;&lsquo;cultural competence&rsquo;&rsquo;, an allegiance to &lsquo;&lsquo;critical awareness&rsquo;&rsquo; prompts the interrogation of received knowledge, for example how human development and personhood is understood, as well stimulating an engagement in the lifelong process of reflecting on one&rsquo;s own ideological and cultural location.

The CDM-Net project : the development, implementation and evaluation of a broadband-based network for managing chronic disease

<b>Background.</b> In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband-based network known as the Chronic Disease Management Service (CDMS). <br /><br /><b>Aims.</b> To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS. <br /><br /><b>Methods.</b> A single cohort before and after study. <br /><br /><b>Results.</b> GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients. <br /><br /><b>Conclusion.</b> This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined.<br />

Working around a contested diagnosis : borderline personality disorder in adolescence

This discourse analytic study sits at the intersection of everyday communications with young people in mental health settings and the enduring sociological critique of diagnoses in psychiatry. The diagnosis of borderline personality disorder (BPD) is both contested and stigmatized, in mental health and general health settings. Its legitimacy is further contested within the specialist adolescent mental health setting. In this setting, clinicians face a quandary regarding the application of adult diagnostic criteria to an adolescent population, aged less than 18 years. This article presents an analysis of interviews undertaken with Child and Adolescent Mental Health Services (CAMHS) clinicians in two publicly funded Australian services, about their use of the BPD diagnosis. In contrast with notions of primacy of diagnosis or of transparency in communications, doctors, nurses and allied health clinicians resisted and subverted a diagnosis of BPD in their work with adolescents. We delineate specific social and discursive strategies that clinicians displayed and reflected on, including: team rules which discouraged diagnostic disclosure; the lexical strategy of hedging when using the diagnosis; the prohibition and utility of informal &lsquo;borderline talk&rsquo; among clinicians; and reframing the diagnosis with young people. For clinicians, these strategies legitimated their scepticism and enabled them to work with diagnostic uncertainty, in a population identified as vulnerable. For adolescent identities, these strategies served to forestall a BPD trajectory, allowing room for troubled adolescents to move and grow. These findings illuminate how the contest surrounding this diagnosis in principle is expressed in everyday clinical practice. <br />

Opportunities for primary and secondary prevention of excess gestational weight gain : General Practitioners’ perspectives

<b>Background</b><br /><br />The impact of excess gestational weight gain (GWG) on maternal and child health outcomes is well documented. Understanding how health care providers view and manage GWG may assist with influencing healthy gestational weight outcomes. This study aimed to assess General Practitioner's (GPs) perspectives regarding the management and assessment of GWG and to understand how GPs can be best supported to provide healthy GWG advice to pregnant women.<br /><b>Methods</b><br /><br />Descriptive qualitative research methods utilising semi - structured interview questions to assess GPs perspectives and management of GWG. GPs participating in shared antenatal care in Geelong, Victoria and Sydney, New South Wales were invited to participate in semi - structured, individual interviews via telephone or in person. Interviews were digitally recorded and transcribed verbatim. Data was analysed utilising thematic analysis for common emerging themes.<br /><b>Results</b><br /><br />Twenty eight GPs participated, 14 from each state. Common themes emerged relating to awareness of the implications of excess GWG, advice regarding weight gain, regularity of gestational weighing by GPs, options for GPs to seek support to provide healthy lifestyle behaviour advice and barriers to engaging pregnant women about their weight. GPs perspectives concerning excess GWG were varied. They frequently acknowledged maternal and child health complications resulting from excess GWG yet weighing practices and GWG advice appeared to be inconsistent. The preferred support option to promote healthy weight was referral to allied health practitioners yet GPs noted that cost and limited access were barriers to achieving this.<br /><b>Conclusions</b><br /><br />GPs were aware of the importance of healthy GWG yet routine weighing was not standard practice for diverse reasons. Management of GWG and perspectives of the issue varied widely. Time efficient and cost effective interventions may assist GPs in ensuring women are supported in achieving healthy GWG to provide optimal maternal and infant health outcomes.<br />

Intentions to quit work among care staff working in the aged care sector

<b>Purpose of the Study:</b> The aged care industry experiences high rates of staff turnover. Staff turnover has significant implications for the quality of care provided to care recipients and the financial costs to care agencies. In this study, we applied a model of intention to quit to identify the contextual and personal factors that shape aged care staff&rsquo;s intention to quit.<br /><b><br />Design and Methods:</b> A sample of 208 aged care staff, including nurses, personal care assistants, allied health professionals, and managers completed a self-report questionnaire. The questionnaire assessed intention to quit, organizational commitment, job satisfaction, self-esteem, stressors, stress, and supervisor support.<br /><br /><b>Results:</b> The findings largely supported the model. Specifically, job commitment, job satisfaction, and work stressors directly influenced intentions to quit, although work stressors and supervisor support demonstrated numerous indirect associations on quitting intentions.<br /><br /><b>Implications:</b> The findings suggest that aged care service providers can modify aged care workers&rsquo; intentions to quit by reducing job stressors and increasing supervisor support.<br />

Shared care for chronic eye diseases : perspectives of ophthalmologists, optometrists and patients

<b>Objective</b>: To report the perspectives of optometrists, ophthalmologists and patients on a model of shared care for patients with chronic eye diseases.<br /><br /><b>Design, setting and participants</b>: Qualitative study of a model of shared care between optometrists and ophthalmologists for patients with stable age-related macular degeneration, diabetic retinopathy and glaucoma, trialled by the Royal Victorian Eye and Ear Hospital in Melbourne during 2007&ndash;2009. Semi-structured interviews were conducted with optometrists, ophthalmologists and patients at completion of the project to obtain their perspectives on this model.<br /><br /><b>Results</b>: Seventeen optometrists submitted expressions of interest to participate, and 12 completed web-based training modules and clinical observerships and adhered to specified examination and reporting protocols. All five participating ophthalmologists and 11 of the optometrists were interviewed. Ninety-eight patients participated and 37 were interviewed. Optometrists not only met ophthalmologists&rsquo; expectations but exceeded them, appropriately detecting and referring patients with additional, previously undetected conditions. Patients reported savings in travel time and were satisfied with the quality of care they received. Optometrists, ophthalmologists and patients indicated a general acceptance of shared care arrangements, although there were some issues relating to interprofessional trust.<br /><br /><b>Conclusions</b>: Shared care between local optometrists and hospital-based ophthalmologists can help to reduce patient waiting time for review and offers an opportunity for these two groups of eye care professionals to collaborate in providing localised care for the benefit of patients. However, trust and relationship building need to be further developed.<br />

Cluster randomized controlled trial of a peer support program for people with diabetes: study protocol for the Australasian peers for progress study

<b>Background</b><br />Well managed diabetes requires active self-management in order to ensure optimal glycaemic control and appropriate use of available clinical services and other supports. Peer supporters can assist people with their daily diabetes self-management activities, provide emotional and social support, assist and encourage clinical care and be available when needed.<br /><b>Methods</b><br />A national database of Australians diagnosed with type 2 diabetes is being used to invite people in pre-determined locations to participate in community-based peer support groups. Peer supporters are self-identified from these communities. All consenting participants receive diabetes self-management education and education manual prior to randomization by community to a peer support intervention or usual care. This multi-faceted intervention comprises four interconnected components for delivering support to the participants. (1) Trained supporters lead 12 monthly group meetings. Participants are assisted to set goals to improve diabetes self-management, discuss with and encourage each other to strengthen linkages with local clinical services (including allied health services) as well as provide social and emotional support. (2) Support through regular supporter-participant or participant-participant contact, between monthly sessions, is also promoted in order to maintain motivation and encourage self-improvement and confidence in diabetes self-management. (3) Participants receive a workbook containing diabetes information, resources and community support services, key diabetes management behaviors and monthly goal setting activity sheets. (4) Finally, a password protected website contains further resources for the participants. Supporters are mentored and assisted throughout the intervention by other supporters and the research team through attendance at a weekly teleconference. Data, including a self-administered lifestyle survey, anthropometric and biomedical measures are collected on all participants at baseline, 6 and 12 months. The primary outcome is change in cardiovascular disease risk using the UKPDS risk equation. Secondary outcomes include biomedical, quality of life, psychosocial functioning, and other lifestyle measures. An economic evaluation will determine whether the program is cost effective.<br /><b>Discussion</b><br />This manuscript presents the protocol for a cluster randomized controlled trial of group-based peer support for people with type 2 diabetes in a community setting. Results from this trial will contribute evidence about the effectiveness of peer support in achieving effective self-management of diabetes.

Enhanced recovery after surgery program for elective adbominal surgery at three Victorian hospitals

The aim of this study was to evaluate the anaesthesia care of an enhanced recovery after surgery (ERAS) program for patients having abdominal surgical in Victorian hospitals. The man outcome measure was the number of ERAS items implemented following introduction of the ERAS program. Secondary endpoints included process of care measures, outcomes and hospital stay. We used a before-and-after design; the control group was a prospective cohort (n=154) representing pre-existing practice for elective abdominal surgical patients from July 2009. The introduction of a comprehensive ERAS program took place over two months and included the education of surgeons, anaesthetists, nurses and allied health professionals. A post-implementation cohort (n=169) was enrolled in early 2010. From a total of 14 ERAS-recommended items, there were significantly more implemented in the post-ERAS period, median 8 (interquartile range of 7 to 9) vs 9 (8 to 10), P &lt;0.0001. There were, however, persistent low rates of intravenous fluid restriction (25%) and early removal of urinary catheter (31%) in the post-ERAS period. ERAS patients had less pain and faster recovery parameters, and this was associated with a reduced hospital stay, geometric mean (SD) 5.7 (2.5) vs 7.4 (2.1) days, P=0.006. We found that perioperative anaesthesia practices can be readily modified to incorporate an enhanced recovery program in Victorian hospitals.<br />