Clinical nurses` response to an environment of health care reform and organizational restructuring

The aim of this paper is to provide an explanation for clinicians' undisputed acceptance of change. This will be performed by examining the process of organizational restructuring across three analytical levels – the macro, meso and micro; identifying the consequences of restructuring for clinical nurses' performance; and evaluating organizational restructuring using a micro-political theoretical framework.

Social factors and obesity: an investigation of the role of health behaviours

OBJECTIVES: This study evaluated a behavioural model of the relation between social factors and obesity, in which differences in body mass index (BMI) across sociodemographic groups were hypothesized to be attributable to social group differences in health behaviours affecting energy expenditure (physical activity, diet and alcohol consumption and weight control).

METHODS: A total of 8667 adults who participated in the 1995 Australian National Health and Nutrition Surveys provided data on a range of health factors including objectively measured height and weight, health behaviours, and social factors including family status, employment status, housing situation and migration status.

RESULTS: Social factors remained significant predictors of BMI after controlling for all health behaviours. Neither social factors alone, nor health behaviours alone, adequately explained the variance in BMI. Gender-specific interactions were found between social factors and individual health behaviours.

CONCLUSIONS: These results suggest that social factors moderate the relation between BMI and weight-related behaviours, and that the mechanisms underlying sociodemographic group differences in obesity may vary among men and women. Additional factors are likely to act in conjunction with current health behaviours to explain variation in obesity prevalence across sociodemographic groups.

Multiple sclerosis and economic well being: role of health, age, and duration of illness

This study used quantitative and qualitative techniques to examine the role of health, age, and duration of illness among people with multiple sclerosis (MS) in their economic well-being. Participants were 113 adults (31 males and 82 females) with MS who lived in urban and rural regions of Australia. The results demonstrated that health and age had a significant impact on both the economic well-being and psychological adjustment of people who contract this disorder. Different health variables predicted different aspects of economic well-being. Fatigue was the major health variable that predicted costs of MS and economic pressure, with age also predicting economic pressure, whereas income levels were predicted by cognitive confusion and mobility problems. Duration of illness, gender, and urban/rural location were not significant predictors of the economic variables. These results demonstrate the importance of obtaining multiple measures of economic well-being, as well as a broad range of health-related measures, in determining the impact of MS on the economic well-being of people with this disorder.

Role of health, relationships, work and coping on adjustment among people with multiple sclerosis: a longitudinal investigation

The current study was designed to evaluate the impact of health, social relationships, work and coping on the adjustment and self-esteem of people with multiple sclerosis (MS). The participants were 251 people with MS (84 men, 167 women) and 184 people from the general population (56 men, 128 women). Data were obtained on the above variables using an anonymous questionnaire. In order to determine the impact of these relationships over time, the questionnaire was completed on two occasions, 18 months apart. The impact of health, social relationships, work and coping at time 1 on adjustment and self-esteem at time 2, was explored. The results indicated that there was a high level of stability in the levels of adjustment and self-esteem among both populations over time. People with MS experienced poorer adjustment and self-esteem, as well as poorer health, lower quality relationships, and lower work capacity than people from the general population. People with MS were also less likely to adopt problem focused or seeking social support coping, and more likely to adopt a detached style of coping. For both the MS and general populations, the most important predictors of adjustment and self-esteem at time 2 were time 1 levels of the same variables, with health, social relationships, work or coping strategies explaining little of the variance in time 2 levels of adjustment. The implications of this level of stability on the psychological adjustment of people with MS are discussed.

A trial of nurse practitioner scope of practice

Aims. The aim of this paper is to report a trial to investigate the feasibility of the nurse practitioner role in local health service delivery and to provide information about the educational and legislative requirements for nurse practitioner practice.

Background. Nurse practitioners have been shown to offer a beneficial service and fill a gap in health care provision. However, the lack of publications describing, critiquing, or defending the way that existing nurse practitioner roles have been developed may lead to a lack of clarity in comparing the nurse practitioner scope of practice internationally. In Australia, credible exploratory research is needed to realize the potential of nurse practitioners to bridge the divide of inequitable distribution of health services. A trial of nurse practitioner services in the Australian Capital Territory provided an excellent opportunity to investigate these scope and continuity issues.

Methods. This was an observational analytic study using multiple data sources. Four models of nurse practitioner service were chosen from a competitive field of applications that were evaluated according to efficacy, feasibility, and sustainability across specified selection criteria. Each model in the trial included a clinical support team, with the nurse practitioner candidate 'working-into-the-role' and collecting demographic, clinical practice, patient outcome, and health service and consumer survey data over a 10 month period.

Findings. The trial identified the broad potential of the nurse practitioner role, its breadth and limitations, and its impact on selected health services in the Australian Capital Territory. Data from individual models were compared highlighting generic elements, and formed the basis for the development of the scope of practice for the Australian Capital Territory nurse practitioner models.

Conclusions. This study has validated a research-based, iterative process for initial development of nurse practitioner scope of practice for any Australian specialization. Importantly, the study concluded with the scope of practice as a finding, rather than commencing with it a priori. Although general areas of health care need and under-servicing were identified at the outset, the process tested both the expansion and parameters of the roles.

Global priority setting for Cochrane systematic reviews of health promotion and public health research

Background: Systematic reviews of health promotion and public health interventions are increasingly being conducted to assist public policy decision making. Many intra-country initiatives have been established to conduct systematic reviews in their relevant public health areas. The Cochrane Collaboration, an international organisation established to conduct and publish systematic reviews of healthcare interventions, is committed to high quality reviews that are regularly updated, published electronically, and meeting the needs of the consumers.

Aims: To identify global priorities for Cochrane systematic reviews of public health topics.

Methods: Systematic reviews of public health interventions were identified and mapped against global health risks. Global health organisations were engaged and nominated policy-urgent titles, evidence based selection criteria were applied to set priorities.

Results: 26 priority systematic review titles were identified, addressing interventions such as community building activities, pre-natal and early infancy psychosocial outcomes, and improving the nutrition status of refugee and displaced populations.

Discussion: The 26 priority titles provide an opportunity for potential reviewers and indeed, the Cochrane Collaboration as a whole, to address the previously unmet needs of global health policy and research agencies.

A methodology of health information security evaluation

With the conversion of paper health records to electronic health records, the health care sector is increasingly relying on technology to maintain the integrity of and update patients’ data. This reliance on technology requires an acute level of protection from technological disasters and/or threats of human error or sabotage. Research has shown there are inadequacies in the installation and use of security controls for health information records and that current methods of security analysis lack the techniques to analyse the technical and social aspects of security. This paper reports on progress towards development of a health information security evaluation methodology based on Unified Modelling Language techniques, and discusses an imminent case study that will be used for validation of the methodology.

Agreement between adolescent self-report and parent reports of health and well-being: results of an epidemiological study.

Objective To examine parent and adolescent agreement on physical, emotional, mental and social health and well-being in a representative population.
Methodology An epidemiological design was used to obtain parent–child/adolescent dyad data on comparable items and scales of a generic measure of health and well-being, the Child Health Questionnaire (parent/proxy report 50 item, self-report 80 item). Scale analysis included intraclass correlations (ICCs) to examine strength of parent–child associations and independent t-tests for differences between adolescents (with or without an illness). Where there were significant differences in scale scores, analysis of variance and two sample t-tests were used to examine the influence of social, demographic, health concern and school variables. Single items were examined for trends in response categories.
Results 2096 parent–adolescent dyads (adolescent mean age of 15.1 years, males 50%, maternal parent 83.2%, biological parent 93.5%). ICCs were strong. Overall, adolescents reported poorer emotional and social health, and clinically significant differences were observed for perceptions of general health (mean difference 8.1/100), frequency and amount of body pain (5.94/100), experience of mental health (5.14/100), and impact of health on family activities (12.43/100), which widen significantly for adolescents with illness. Social, health and school enjoyment and performance significantly widened parent–child differences.
Conclusions All adolescents were much less optimistic about their health and well-being than their parents, and were only in close agreement on aspects of health and well-being they rated highly. Adolescent reports are more likely to be sensitive to pain, mental health problems, health in general and the impact of their health on family activities.

Modelling the marketing of place by local government in Australia

Much of Regional Australia is suffering from an overall decline in population with a specific loss of young adults (16-30 year olds). A decline in population, linked with the Australia-wide problems of ageing populations and diminishing birth rates, is leading to a social and economic malaise in many regional cities and towns that threatens their long-term sustainability due to the lack of skilled workers and professionals. This paper examines the concept of “place” marketing, and the approach of local government to market regions, cities, and towns to attract targeted population to help maintain the sustainability of Regional Australia.

Marketing of place to attract and retain population in regional Australia

In Australia, as in many other developed countries, regional and rural areas are suffering from an overall decline in population with a specific loss of young adults (16-30 year olds). A decline in population, linked with the Australia-wide problems of ageing populations and diminishing birth rates, is leading to a social and economic decline in many regional cities and towns that threatens their long-term sustainability due to the lack of skilled workers and professionals. Although the loss of population from regional and rural areas has the potential to affect the national economy, it has mainly fallen to local government to combat the problem. Local government is beginning to use place marketing to attract and retain residents in addition to its traditional use of place marketing to attract industry and investment.

This exploratory paper examines regional decline in Australia and the concept of "place" marketing as means of arresting or reversing the decline, A conceptual model of place marketing by local government in Australia has been developed and a number of hypothesis are proposed for testing in future research.

Agents for invocation of web services

Web services are becoming popular and widely accepted on the Internet. UDDI is the standard for publishing and discovery of web services. In this paper, we investigate semantics description of web services based on domain ontology; based on this language, we propose an architecture for invoking agents to consume services within the UDDI registry. The semantics service description language together with agent creation
architecture provides a new way to discover and utilise published web services. This method is flexible and extendable to accomplish complex web service requests.

The privatisation of telecommunications services : comparison of the developed and developing countries

The telecommunication sector in most countries was managed by the government for a long period. Government provision led to poor delivery of services, poor cost recovery, heavy subsidies and pOOl' maintenance. Privatisation was adopted as a means of overcoming these problems in the telecommunications sector in most developing countries. However, the results were not as expected due to poor privatisations processes, absence of genuine regulatory structure and unnecessary interference from the government. Hence the teledensity, breakages, call completion times, and tariff levels have not improved significantly compared to the developed countries.

Stories of ambivalence : Australian executives' experiences of outplacement services

The increasing prevalence of organizational downsizing has been matched by growth in the provision of outplacement services. Yet there has been limited research on either the effectiveness of these programs or the experience of individuals undertaking them. Within a qualitative study investigating the experiences of Australian executives who had been made redundant, one of the focus areas explored was the experience of using outplacement services. Respondents' stories revealed a sense of ambivalence towards these programs. This paper discusses the conflicting experiences giving rising to this ambivalence, namely, positive outcomes with respect to the use of office services and the receiving of proactive support, and more negative aspects of an absence of counselling skills and impersonal treatment through the organizational exit process. It is argued that further research on the outplacement experience is required to determine the type and quality of services which will best serve those who have been made redundant.

The role of the print media in informing the community about safety in public hospitals in Victoria, Australia: the case of `golden staph`

Objective. In this article the authors explore how the print media contribute to information and education of the community on issues of safety and quality in the health services, since this is an important avenue of such information and education for many members of the community. Study design. The authors undertook a qualitative study of a random sample of articles in the Australian print press between 1996 and 2004 where ‘golden staph’ was presented as a major issue of risk to the safety of consumers of health services. The content of each article was examined with reference to several criteria including title, the source of the article, and the metaphorical language employed by the journalist.
Results. Results show that while the articles are substantially accurate as sources of information on concrete events, they do not serve as sources of education on issues of safety, typically apportioning blame and serving to maintain the status quo.
Conclusion. The authors conclude that print media are not a good source of community education in areas of safety and quality and do not assist members of the community to participate in addressing issues of safety in health services.