Advanced practice: A survey of current perspectives of Australian pharmacists

Background An Advanced Pharmacy Practice Framework for Australia (the ‘APPF’) was published in October 2012. Further to the release of the APPF, the Advanced Pharmacy Practice Framework Steering Committee planned to develop an advanced practice recognition model for Australian pharmacists. Aim To gauge the perspectives of the pharmacy profession relating to advanced practice, via an online survey, in order to inform the design of the model. Method A survey was developed and administered to Australian pharmacists through SurveyMonkey . The survey content was based on findings from a review of national and international initiatives for recognition of advanced practice in pharmacy and other health disciplines, including medicine and nursing. Results The results of the survey showed that a high proportion of respondents considered they were already working at, or working towards achieving, an advanced level of practice. The responses relating to the assessment methods showed a clear preference for ‘submission of a professional portfolio’. A ‘written examination’ had a low level of support and in relation to an ‘oral examination by a panel’ there was a marked preference for a panel of multidisciplinary health professionals over a panel of pharmacists. Conclusion The survey outcomes will inform the development of an advanced pharmacy practice recognition model for Australian pharmacists, particularly in relation to the assessment methods. Survey outcomes also demonstrated that there is scope to further enhance the application of the APPF in the development and recognition of advanced practitioners, and to build greater awareness of the breadth of competencies encompassed by ‘advanced practice’.

An Advanced Pharmacy Practice Framework for Australia

The need to develop An Advanced Pharmacy Practice Framework for Australia (the “APPF”) was identified during the 2010 review of the competency standards for Australian pharmacists. The Advanced Pharmacy Practice Framework Steering Committee, a collaborative profession-wide committee comprised of representatives of ten pharmacy organisations, examined and adapted existing advanced practice frameworks, all of which were found to have been based on the Competency Development and Evaluation Group (CoDEG) Advanced and Consultant Level Framework (the “CoDEG Framework”) from the United Kingdom. Its competency standards were also found to align well with the Domains of the National Competency Standards Framework for Pharmacists in Australia (the “National Framework”). Adaptation of the CoDEG Framework created an APPF that is complementary to the National Framework, sufficiently flexible to customise for recognising advanced practice in any area of professional practice and has been approved by the boards/councils of all participating organisations. The primary purpose of the APPF is to assist the development of the profession to meet the changing health care needs of the community. However, it is also a valuable tool for assuring members of the public of the competence of an advanced practice pharmacist and the quality and safety of the services they deliver.

Australian pharmacists' self-perceptions in relation to the 'Advanced Pharmacy Practice Framework'

Background The Australian Pharmacy Practice Framework was developed by the Advanced Pharmacy Practice Steering Committee and endorsed by the Pharmacy Board of Australia in October 2012. The Steering Committee conducted a study that found practice portfolios to be the preferred method to assess and credential Advanced Pharmacy Practitioner, which is currently being piloted by the Australian Pharmacy Council. Credentialing is predicted to open to all pharmacists practising in Australia by November 2015. Objective To explore how Australian pharmacists self-perceived being advanced in practice and how they related their level of practice to the Australian Advanced Pharmacy Practice Framework. Method This was an explorative, cross-sectional study with mixed methods analysis. Advanced Pharmacy Practice Framework, a review of the recent explorative study on Advanced Practice conducted by the Advanced Pharmacy Practice Framework Steering Committee and semi-structured interviews (n = 10) were utilized to create, refine and pilot the questionnaire. The questionnaire was advertised across pharmacy-organizational websites via a purposive sampling method. The target population were pharmacists currently registered in Australia. Results Seventy-two participants responded to the questionnaire. The participants were mostly female (56.9%) and in the 30–40 age group (26.4%). The pharmacists self-perceived their levels of practice as either entry, transition, consolidation or advanced, with the majority selecting the consolidation level (38.9%). Although nearly half (43.1%) of the participants had not seen the Framework beforehand, they defined Advanced Pharmacy Practice similarly to the definition outlined in the Framework, but also added specialization as a requirement. Pharmacists explained why they were practising at their level of practice, stating that not having more years of practice, lacking experience, or postgraduate/post-registration qualifications, and more involvement and recognition in practice were the main reasons for not considering themselves as an Advanced Pharmacy Practitioner. To be considered advanced by the Framework, pharmacists would need to fulfill at least 70% of the Advanced Practice competency standards at an advanced level. More than half of the pharmacists (64.7%) that self-perceived as being advanced managed to fulfill 70% or more of these Advanced Practice competency standards at the advanced level. However, none of the self-perceived entry level pharmacists managed to match at least 70% of the competencies at the entry level. Conclusion Participants' self-perception of the term Advanced Practice was similar to the definition in the Advanced Pharmacy Practice Framework. Pharmacists working at an advanced level were largely able to demonstrate and justify their reasons for being advanced practitioners. However, pharmacists practising at the other levels of practice (entry, transition, consolidation) require further guidance regarding their advancement in practice.

Developing a Best Management Practice guideline for the Australian Banana Industry

Demonstrating environmental performance and sustainability is a strategic priority for the Australian banana industry. Development, delivery and uptake of an EMS will allow the industry to demonstrate this. It will maintain community confidence in the Australian banana industry and its commitment to careful environmental management and the protection of key Australian icons like the Great Barrier Reef and the Wet Tropics and ensure the industry’s right to farm, now and in the future.

Feedback and clinical practice improvement: A tool to assist workplace supervisors and students

In work integrated learning, students may report difficulties applying theory learned at university to clinical practice. One contributing factor may be students' inability to engage in meaningful reflection and self-correcting behaviours. This paper reports the evaluation of a tool, process and resources developed to assist students to reflect on feedback and engage in self-assessment. Students were assisted to develop self-assessment skills by reflecting on, and engaging with feedback from previous workplace experiences to develop goals, learning outcomes and strategies to improve performance with mostly positive results. A secondary aim was to identify common learning strategies or barriers that impacted on student outcomes. Four themes emerged from the qualitative data: 1) preparing for clinical learning; 2) relationships and engagement levels; 3) shared awareness, and; 4) developing clinical practice. Overall students felt the tool assisted them to narrow their attention on what needed to be improved. While supervisors believed the tool helped them to focus on specific needs of each student. Common barriers to clinical practice improvement related to a lack of opportunity in some settings, and lack of staff willingness to support students to achieve identified goals. Students and supervisors found the use of the tools beneficial and assisted students to demonstrate a greater understanding of how to apply feedback received to support their learning in the clinical environment.

Australian hardwood drying best practice manual. Part 2

This manual is a guide to establishing a set of operations to achieve high grade results in product quality and recovery, flexibility, innovation, cost, and competitiveness. The manual outlines: - economic and feasible technologies for increasing recovery and reducing avoidable loss during processing, from the log to the finished board, and - mechanisms that allow production value to be optimised in different sized mills. Part 2 includes sections 8 to 17: Air drying, pre-drying, reconditioning, controlled final drying, dry milling, storage, information assessment, drying quality assessment, moisture content monitoring, glossary. Part 1 Link: http://era.deedi.qld.gov.au/3138 Covers sections 1 to 7: Drying overview and strategy, coupe, log yard, green mill, green pack, bioprotection, rack timber.

Australian hardwood drying best practice manual. Part 1

This manual is a guide to establishing a set of operations to achieve high grade results in product quality and recovery, flexibility, innovation, cost, and competitiveness. The manual outlines: - economic and feasible technologies for increasing recovery and reducing avoidable loss during processing, from the log to the finished board, and - mechanisms that allow production value to be optimised in different sized mills. Part 1 covers sections 1 to 7: Drying overview and strategy, coupe, log yard, green mill, green pack, bioprotection, rack timber. Part 2 Link: http://era.deedi.qld.gov.au/3137 Includes sections 8 to 17: Air drying, pre-drying, reconditioning, controlled final drying, dry milling, storage, information assessment, drying quality assessment, moisture content monitoring, glossary.

Estimating the economic implications for grazing properties in the Mackay Whitsunday catchments of practice changes to more sustainable landscapes.

In the Mackay Whitsunday region, the dominant grazing based operations are small intensive systems that heavily utilise soil, nutrient and chemical management practices. To improve water quality entering the Great Barrier Reef, graziers are being encouraged to adopt improved management practices. However, while there is good understanding of the management changes required to reach improved practice classification levels, there is poor understanding of the likely economic implications for a grazier seeking to move from a lower level classification to the higher level classifications. This paper provides analysis of the costs and benefits associated with adoption of intensive grazing best management practices to determine the effect on the profitability and economic sustainability of grazing enterprises, and the economic viability of capital investment to achieve best management. The results indicate that financial incentives are likely to be required to encourage smaller graziers to invest in changing their management practices, while larger graziers may only require incentives to balance the risk involved with the transition to better management practices.

Impact of the Australian litter re-use practice on Salmonella in the broiler farming environment

This study has examined the dynamics (in terms of levels and serovar diversity) of Salmonella in the "dual litter environment" that occurs within a single shed as a result of a management practice common in Australia. The study also looked at the physical parameters of the litter (pH, moisture content, water activity and litter temperature) as a means of understanding the Salmonella dynamics in these litter environments. The Australian practice results in the brooder end of the shed having new litter each cycle while the grow-out end has re-used litter (a "dual litter environment"). Two farms that adopted this partial litter re-use practice were studied over one full broiler cycle each. Litter was sampled weekly for the levels (and serovars) of Salmonella during a farming cycle. There was a trend for lower levels of Salmonella (and a lower Salmonella serovar) diversity in the re-used litter environment as compared with the new litter environment. Of the physical parameters examined, it would appear that the lower water activity associated with the re-used litter may contribute to the Salmonella dynamics in the dual environment.

Driving better vegetable irrigation through profitable practice change

The availability and quality of irrigation water has become an issue limiting productivity in many Australian vegetable regions. Production is also under competitive pressure from supply chain forces. Producers look to new technologies, including changing irrigation infrastructure, exploring new water sources, and more complex irrigation management, to survive these stresses. Often there is little objective information investigating which improvements could improve outcomes for vegetable producers, and external communities (e.g. meeting NRM targets). This has led to investment in inappropriate technologies, and costly repetition of errors, as business independently discover the worth of technologies by personal experience. In our project, we investigated technology improvements for vegetable irrigation. Through engagement with industry and other researchers, we identified technologies most applicable to growers, particularly those that addressed priority issues. We developed analytical tools for ‘what if’ scenario testing of technologies. We conducted nine detailed experiments in the Lockyer Valley and Riverina vegetable growing districts, as well as case studies on grower properties in southern Queensland. We investigated root zone monitoring tools (FullStop™ wetting front detectors and Soil Solution Extraction Tubes - SSET), drip system layout, fertigation equipment, and altering planting arrangements. Our project team developed and validated models for broccoli, sweet corn, green beans and lettuce, and spreadsheets for evaluating economic risks associated with new technologies. We presented project outcomes at over 100 extension events, including irrigation showcases, conferences, field days, farm walks and workshops. The FullStops™ were excellent for monitoring root zone conditions (EC, nitrate levels), and managing irrigation with poor quality water. They were easier to interpret than the SSET. The SSET were simpler to install, but required wet soil to be reliable. SSET were an option for monitoring deeper soil zones, unsuitable for FullStop™ installations. Because these root zone tools require expertise, and are labour intensive, we recommend they be used to address specific problems, or as a periodic auditing strategy, not for routine monitoring. In our research, we routinely found high residual N in horticultural soils, with subsequently little crop yield response to additional nitrogen fertiliser. With improved irrigation efficiency (and less leaching), it may be timely to re-examine nitrogen budgets and recommendations for vegetable crops. Where the drip irrigation tube was located close to the crop row (i.e. within 5-8 cm), management of irrigation was easier. It improved nitrogen uptake, water use efficiency, and reduced the risk of poor crop performance through moisture stress, particularly in the early crop establishment phases. Close proximity of the drip tube to the crop row gives the producer more options for managing salty water, and more flexibility in taking risks with forecast rain. In many vegetable crops, proximate drip systems may not be cost-effective. The next best alternative is to push crop rows closer to the drip tube (leading to an asymmetric row structure). The vegetable crop models are good at predicting crop phenology (development stages, time to harvest), input use (water, fertiliser), environmental impacts (nutrient, salt movement) and total yields. The two immediate applications for the models are understanding/predicting/manipulating harvest dates and nitrogen movements in vegetable cropping systems. From the economic tools, the major influences on accumulated profit are price and yield. In doing ‘what if’ analyses, it is very important to be as accurate as possible in ascertaining what the assumed yield and price ranges are. In most vegetable production systems, lowering the required inputs (e.g. irrigation requirement, fertiliser requirement) is unlikely to have a major influence on accumulated profit. However, if a resource is constraining (e.g. available irrigation water), it is usually most profitable to maximise return per unit of that resource.

Building capacity for cancer nursing research and evidence based practice: The cancer nursing professorial precinct initiative

The demand for cancer care is growing due to the increasing incidence of cancer and the improved effectiveness of cancer treatments. It is important that cancer nurses continue to improve patient outcomes through research and the use of evidence in practice development, education and policy. This paper describes a case report of a collaborative academic healthcare model that creates capacity for cancer nursing research and evidence-based practice. The Cancer Nursing Professorial Precinct is a strategic collaboration between the Royal Brisbane and Women’s Hospital (RBWH) and Queensland University of Technology (QUT), in Brisbane Australia. The outcomes of this initiative has been remarkable. The principles and strategies used in this initiative may be useful for cancer services in other countries.

Is stereotype threat a useful construct for organizational psychology research and practice?

Stereotypes about different groups persist in organizations. Employees from such groups may experience stereotype threat, or the concern that they are being judged on the basis of demeaning stereotypes about groups to which they belong. The goal of this focal article is to discuss whether stereotype threat is a useful construct for organizational psychology research and practice. To this end, we focus on consequences other than acute performance deficits in laboratory settings. In particular, we examine studies that highlight the effects of stereotype threat on intrapersonal outcomes (e.g., job attitudes), interpersonal outcomes (e.g., negotiation), and on the relationship between employees and their organization. The research reviewed suggests that stereotype threat is a potentially important phenomenon in organizations, but it also highlights the paucity of research in an organizational context. We provide suggestions for future research directions as well as for the prevention and amelioration of stereotype threat in the workplace.

Japanese plums (Prunus salicina Lindl.) and phytochemicals – breeding, horticultural practice, post-harvest storage, processing and bioactivity

Previous reviews of plum phytochemical content and health benefits have concentrated on the European plum, Prunus domestica L.. However, the potential bioactivity of red and dark red fleshed Japanese plum, Prunus salicina Lindl., so called blood plums, appears to warrant a significant increase in exposure as indicated in a recent review of the whole Prunus genus. Furthermore, Japanese plums are the predominate plum produced on an international basis. In this review the nutrient and phytochemical content, breeding programs, horticultural practice, post harvest treatment and processing as well as bioactivity (emphasizing in vivo studies) of Japanese plum are considered with a focus on the anthocyanin content that distinguishes the blood plums.

Response: Special communication: Letters to the Editor-in-Chief [Vigorous exercise in clinical practice: balancing risks and benefits]

The effects of different exercise intensities on health have been investigated in several studies in recent years, in which some authors showed greater benefits for vigorous exercise (6) while others did not find any differences (8). An important issue regarding these conflicting results could be the fact that only a few of the studies controlled the effects of different exercise intensities for the overall volume of physical activity, making the evaluation of the available data difficult.

Book Review: "Safe Design and Construction of Machinery – Regulation, Practice and Performance [First edition]"

With Safe Design and Construction of Machinery, the author presents the results of empirical studies into this significant aspect of safety science in a very readable, well-structured format. The book contains 436 references, 17 tables, one figure and a comprehensive index. Liz Bluff addresses a complex and important, but often neglected domain in OHS – the safety of machinery – in a holistic and profound, yet evidence based analysis; with many applied cases from her studies, which make the book accessible and a pleasant lecture. Although research that led to this remarkable publication might have been primarily focused on the regulators, this book can be highly recommended to all OHS academics and practitioners. It provides an important contribution to the body of knowledge in OHS, and establishes one of the few Australian in-depth insights into the significance of machinery producers, rather than machinery users in the wider framework of risk management. The author bases this fresh perspective on the well-established European Machinery Safety guidelines, and grounds her mixed-methods research predominantly in qualitative analysis of motivation and knowledge, which eventually leads to specific safety outcomes. It should be noted that both European and Australian legal aspects are investigated and considered, as both equally apply to many machinery exporters. A detailed description of the research design and methods can be found in an appendix. Overall, the unique combination of quantitative safety performance data and qualitative analysis of safety behaviours form a valuable addition to the understanding of machinery safety. The author must be congratulated on making these complex relationships transparent to the reader through her meticulous inquiry.