New money for mental health : will it make things better for rural and remote Australia?

New Australian government funding for the Better Outcomes in Mental Health Care initiative is a significant step forward for mental health, with general practitioners now able to offer direct referrals to psychologists, social workers, occupational therapists and Aboriginal health workers. Incentives for better teamwork between GPs and other mental health professionals have been introduced, but may have unintended consequences, including an exacerbation of workforce shortages in rural and remote areas. Possible solutions to these shortages include rural scholarships for students in the mental health professions; recruitment and retention of students coordinated by university departments of rural health; better access to continuing professional development; and federally funded rural positions and additional financial incentives for rural mental health practitioners.

Metabolic and cardiac outcomes after acute myocardial infarction

The original DIGAMI protocol recommended using intravenous insulin to manage myocardial infarction from first presentation followed by subcutaneous insulin for 3 months in patients with diabetes. This paper describes the metabolic and cardiac outcomes and barriers to implementing a protocol designed to match the DIGAMI principles across our emergency and cardiology departments. Patients managed using the revised DIGAMI protocol achieved better blood glucose control and had fewer reinfarcts than those managed without insulin. The major barrier to using the protocol appeared to be staff fear of causing hypoglycaemia.

Ethics in a capitalistic society

The problem of semantics is inherent in any discussion of ethics. The general term "ethics" is itself commonly confused. In addition, systems of ethics must be built upon assumptions, and assumptions are necessarily subject to lengthy debate. These two problems are encountered in my investigation of the ethical practices of the modern business community and to remedy the situation I have taken two steps: the first being an attempt to clarify the meaning of terms used therein;-and the second being a clear description of the assumptions utilized to further my analysis. To satisfy those who would disagree with these assumptions, I have attempted to outline the consequences of differing premises. The first assumption in my discussion is that the capitalistic economy is powered by the motivation supplied by man's self-interest. We are conditioned to basing our courses of action upon an orientation toward gratifying this self-interest. Careers are chosen by blending aptitude, interest, and remuneration. of course, some people are less materially inclined than others, but the average member of our capitalistic society is concerned with the physical rewards derived from his employment. Status and happiness are all-important considerations in pursuing a chosen course of action, yet all too often they are measured in physical terms. The normal self-interest natural to mankind is heightened in capitalism, due to the emphasis placed upon material compensation. Our thinking becomes mechanistic as life devolves into a complex game played by the rules. We are accustomed to performing meaningless or unpleasant duties to fulfill our gratifications. Thought, consequently, interferes with the completion of our everyday routines. We learn quickly not to be outspoken, as the outspoken one threatens the security of his fellow man. The majority of the people are quite willing to accept others views on morality, and indeed this is the sensible thing to do as one does not risk his own neck. The unfortunate consequence of this situation has been the substitution of the legal and jural for the moral and ethical. Our actions are guided by legal considerations and nowhere has this been more evident than in the business community. The large legal departments of modern corporations devote full time to inspecting the legality of corporate actions. The business community has become preoccupied with the law, yet this is necessarily so. Complex, modern, capitalistic society demands an elaborate framework of rules and regulations. Without this framework it would be impossible to have an orderly economy, to say nothing of protecting the best interests of the people. However, the inherent complexities, contradictions, and sometimes unfair aspects of our legal system can tempt men to take things into their own hands. From time to time cases arise where men have broken laws while acting in good faith, and other cases where men have been extremely unethical without being illegal. Examples such as these foster the growth of cynicism, and generally create an antagonistic attitude toward the law on the part of business. My second assumption is that the public, on the whole, has adopted an apathetic attitude toward business morality. when faced with an ethical problem, far too many people choose to cynically assume that, if I don't do it someone else will. "The danger of such an assumption lies in that it eliminates many of the inhibitions that normally would preclude unethical action. The preventative factor in contemplating an unethical act not only lies in it going against the "right course of action", but also in that it would display the actor as one of the few, immoral practitioners. However, if the contemplator feels that many other people follow the same course of action, he would not feel himself to be so conspicuous. These two assumptions underly my entire discussion of modern business ethics., and in my judgment are the two most important causal factors in unethical acts perpetrated by the business community. The future elimination of these factors seems improbable, if not futile, yet there is no reason to consider things worse than they ever have been before. The heightened public interest in business morality undoubtedly lies in part in the fact that examples of corporate malpractice are of such magnitude in scope, and hence more newsworthy.

The interface of acute and aged care: the role of the nurse in provincial area

Objective: This study was to investigate issues that arose from pre-admission to post-discharge, for people in Toowoomba, Queensland over the age of 65 admitted to an acute facility. This paper concentrates on a significant concern that emerged from the latge amount of data collected during this project, that is, the role of the nurse in the continuum of health care involving elderly people.

Method: The study involved a multi-site, multi-agency and multi-method (qualitative and quantitative) approach. Data was collected from regional service providers, the Department of Health and Aged Care (DHAC), the Australian Bureau of Statistics (ABS), Home and Community Care (HACC), the Aged Care Assessment Team (ACAT), elderly people who had been discharged from regional hospitals and their carers, residents of regional aged care facilities, area health professionals and elderly regional hospital inpatients.

Results: The data indicated that nurses in this provincial area currently play a limited role in preadmission planning, being mostly concerned with elective surgery, especially joint replacements. While nurses deliver the majority of care during hospitalisation, they do not appear to be cognizant of the needs of the elderly regarding post-acute discharge.

Conclusion: The recent introduction of the model of nurse case management in the acute sector appears to be a positive development that will streamline and optimise the health care of the elderly across the continuum in the Toowoomba area. The paper recommends some strategies, such as discharge liaison nurses based in Emergency Departments and the expansion of the nurse case management role, which would optimise care for the elderly person at the interface of care.

Is there a need for cyberethics in the middle school curriculum

This research in progress is a qualitative and quantitative case study that is exploring the need for the integration of cyberethics into the curriculum for the middle school years 6 through 8. The broader research question in the study investigates: ‘Is there a problem with how school students in the middle years use the Internet in and out of school?’ The study has been exploring the level of understanding the group of students have of ethical behaviour on the Internet. This research helps identify areas where an understanding of cyberethics will increase students’ current and future understanding in the use of the Internet and their interaction with other aspects of the Internet and its environment. If a student encounters unsafe behaviour on the Internet, the student will be able to behave and act appropriately. The research is also investigating teachers and parents perceptions of the evidence of problems associated with their students/children’s access to the Internet.

This area was chosen for research because of the significant impact computers have had in education in the last decade. Since the advent of personal computers and networking the Education Departments in many developed nations have taken the opportunity to promote the technology’s educational benefits. There have been several studies on the educational value of computers in schools and the research thus far describes some of the ethical changes that have emerged as a result of the technology as well as the benefits and shortcomings of the use of this technology within the Australian environment as compared to its usage in other Western nations, namely the U.S. and U.K.

Identifying the problems in the use of the Internet by middle school students is a part of this investigation and it will make recommendations with regard to the integration of cyberethics into the middle school curriculum. This approach will help prompt students, teachers and parents to re-examine their decision framework with regard to Internet usage and hence move them to reflect and consider the use of the technology ethically. Further the research is examining students’, parents’ and teachers’ need for the introduction of cyberethics into the curriculum. The case study is drawing data from individual surveys of parents, teachers and students. The questionnaires consist of relevant scenarios so that it may identify the general understanding and use of the Internet by students, teachers and parents.

During the study, any modification to the curriculum for the integration of cyberethics is to be identified and these findings should be of interest to the wider educational community in Australia and New Zealand. The questions raised in this research may affect teacher education and help demonstrate the importance of the parents’ role in their children’s Internet usage. The research will cover current issues of cyberethics and its effects on middle school students.

Managing FM (support services): business risks in the healthcare sector

This paper presents research findings of 365 NHS Trust executives in the UK and builds on work carried out on risk perceptions and treatment in facilities management operations and business support activities in the NHS Trusts. The research utilises a business approach of viewing healthcare facilities not only as fixed “assets” occupying hospital sites and space, but it also considers them as that “tangible” part of the service chain process underpinning the provision of clinical services to both internal (departments or directorates) and external customers. The research found that customer satisfaction, service delivery certainty, customer involvement, service quality reliability, health and safety are highly rated by the NHS executives. The paper classifies healthcare related risk constructs into seven elements namely: customer care, corporate, legal, commercial finance and economics, business transfer, and facilities transmitted

An urgent challenge: new training opportunities for junior medical officers

There will be a massive increase in the number of medical school graduates over the next 5–10 years — there were 1287 Australian resident graduates in 2004, and there will be more than 3000 by the middle of the next decade.

A workshop held during the 11th National Prevocational Medical Education Forum explored ways to provide the additional prevocational training posts that will be required.

Four possible sites for additional training posts were discussed:
         • expansion of public hospital training posts;
         • general practice;
         • private hospitals; and
         • other sites, including private rooms and community placements.

Current accreditation procedures will need to be amended to accommodate more interns.

There will be limited access to prevocational training posts for non-resident (full-fee-paying) graduates and international medical graduates.

There is an urgent need for postgraduate medical councils, state health departments, the federal government, and medical boards to work together to identify, develop and accredit new training posts.

Review of the role of emergency nurses in management of chemotherapy-related complications

Aims and objectives : To examine the role of emergency nurses in caring for patients who receive chemotherapy in ambulatory oncology settings. Reasons for emergency department presentations are examined, specific sources of clinical risk for patients receiving chemotherapy who require emergency care are discussed and cost implications of emergency department presentations related to chemotherapy are analysed.

Background : Given the increased administration of chemotherapy in ambulatory settings, emergency nurses play an important role in the management of patients undergoing adjuvant chemotherapy. Emergency departments are the major entry point for acute inpatient hospital care of complications arising from chemotherapy.

Design : Systematic review.

Results : Chemotherapy-related emergency department presentations have considerable clinical and cost implications for patients and the healthcare system. Strategies to improve emergency department management of chemotherapy complications and reduction in preventable emergency department presentations has significant implications for improving cancer patients' quality of life and reducing the cost of cancer care.

Conclusions : Nurses are well placed to play a pivotal role in chemotherapy management and lead interventions such as a specialist oncology nursing roles that provide information and support to guide patients through their chemotherapy cycles. These interventions may prevent emergency department presentations for patients receiving chemotherapy in ambulatory settings.

Relevance to clinical practice : Patients receiving chemotherapy require access to specialised care to manage distressing symptoms, as they are at significant clinical risk because of immunosuppression and may not exhibit the usual signs of critical illness. A team approach both within and across nursing specialities may improve care for patients receiving chemotherapy and increase effective use of healthcare resources.

Problems and solutions on land reservation system of small and medium-sized cities in China

Based on the analysis of the basic principal of land reservation system of small and medium-sized cities, this paper gives detailed discuss on many problems which exist during the process of land reservation system, such as unclear function position of land reservation organization, single capital resource, unfair land compensation standard and incomplete urban design. It also submits the proposal—choosing one scientific model, establishing suitable organization, opening more channels for raising funds, and setting up reasonable land compensation standard to unify the land reservation in small and medium-sized cities, improve the efficacy of reserve departments, adjust and standardize the land market in order to promote the healthy development of small and medium-sized cities in the long term.

Teacher education for rural communities : a focus on 'incentives'

In Australia we face a national crisis in attracting and retaining teachers and other professionals with regard to rural areas. In response to this difficulty in ‘staffing the empty schoolhouse’ (Roberts 2004), the majority of state  education departments have initiated some form of rural incentive scheme designed to attract teachers to rural schools. This paper argues that such  schemes have little chance of success unless teachers taking up such  incentives have actually been prepared for teaching in nonmetropolitan   schools. Although many universities claim to prioritise rural and regional  education and community development as part of their vision statements, in reality relatively few education providers reflect this rhetoric in their practice  and only a handful have made direct links to such state-based schemes in  pre-service teacher education, or initiated their own rural incentives. A  preliminary study into pre-service preparation and rural incentive schemes, as part of a three-year ARC Discovery Grant, indicates that, nationally, the  majority of Faculties and Schools of Education have no easily accessible or  advertised incentive programs to encourage students to undertake a rural  practicum. Nor do many reflect rural education in their course-work.

This paper will introduce the ‘TERRAnova’ project, and then discuss findings of the preliminary work to date that has focussed on identifying incentives and their significance. Drawing on evidence collected from websites from   Australian Universities representing all pre-service teacher education programs in the nation, we argue that few Faculties and Schools appear to  see it necessary or desirable to provide students with links to information  about particular state-based rural funding opportunities. We show how some, either directly or indirectly, imply the importance of a rural practicum, and that  a few teacher education programs provide written advice to students who  are considering taking up a rural practicum. It is unclear, however, whether  follow-up advice is provided, so that the impact and effectiveness of such advice on students’ experiences and willingness to take rural education   seriously can be questioned. Our analysis so far indicates that it is the regional universities which are more likely to address rural education needs, and on this basis we question the metro-centricity of teacher education practice more broadly and suggest ways of expanding the options of teachers in their initial teaching appointments.

Ethical, economic and efficient sector : is it a gamble? The case of New Zealand Health

The New Zealand public sector has gone through major reform as a result of fiscal deficit in 1984 (KettI, 1997; Schwartz, 1997), resulting in shift of emphasis from quality service provision to establishing financial supremacy (Kettl, 1997). This raises concern as to how public sector employees are attaining balance between their service objectives with financial ones and how is the ethics negotiated in this process. Following this concern, this paper focuses on determining the organisational variables consisting of organisational policies in the District Health Boards (DHBs) and hospitals of New Zealand on ethical behaviours of managers and the ethical climate of these departments. The aim of this study is to increase our understanding of the ethical climate of the public health. Our findings suggest that little emphasis has been provided to the aspect of ethics in New Zealand health sector. There is no reward for employees who exhibit exemplary ethical behaviour, no hot line to consult/report about ethics, any detailed guidelines and policies, and not enough ethics-related training provided to staff.

Accounting services and SMEs : an Australian study

Background: The observance of regulation has become a fundamental part of life for the conduct of business around the world. Governments and their duly appointed designates, acting in the interest of the collective public, have relied on regulation to moderate economic and social behaviour through the imposition and enforcement of rules. While it can be commonly accepted that such a prescriptive framework may be necessary for the achievement of desired economic and social outcomes, regulation does impose costs on society and on individual firms. These costs, which can include the costs for government departments to administer, the cost for firms to comply, and the multitude of indirect costs such as lost innovation and productivity or their interrelated opportunity costs, have received ample attention.

Accountants are key advisers to all businesses on all aspects of doing business, including regulation. As such, it is appropriate that ACCA has sponsored this study, which explores the regulatory issues facing SMEs and the critical role that accountants and other organisations play in helping SMEs be aware of, comply with and generally manage effectively the regulations that apply to their business.

ACCA has consistently argued for a balanced view to be taken on regulation, recognising that certain rules are necessary for the fair development of business and for employees’ rights. Yet at the same time, ACCA recognises that SMEs are likely to be disproportionately burdened by regulatory requirements and, as a consequence, it actively campaigns for fairness in regulation, recognising the issue as a significant factor in the success, productivity and growth of small businesses.

Overview: This study complements similar research commissioned by ACCA in the United Kingdom and Canada (Blackburn et al. 2006), with the aim of helping to provide a more international picture of the effects of regulation on adviceseeking by SMEs and how accountants can help SMEs meet their regulatory obligations.

The research commenced in November 2006 and was conducted over the Australian summer period 2006/7, among SMEs and accounting practices, as follows:

* telephone survey among 250 SMEs
* postal survey among 130 accounting practitioner firms.

Key findings: The SME section of this study revealed the following points.

* Most SMEs (between 70% and 80%), agreed that the regulations under review were reasonable, however there were significantly high levels of concern regarding:
* the number of regulations affecting their business (80%)
* staying up to date with changing regulations (80%)
* complexity of regulation or the ease of understanding regulations (77%)
* inequity, or the cost of regulation in proportion to the business (66%)
* duplication, or being required to provide the same information to more than one government department (55%).
* External accountants were the most common source of advice, being used by 72% of SMEs; this was followed by federal government agencies,    62%; trade or industry bodies, 61%; and a lawyer or solicitor, 53%.
* Highest levels of satisfaction with the advice provided were recorded for lawyers/solicitors (94%), banks (91%) and external accountants (90%).
* Overall, 80% of SMEs who had used accountants rated their service as excellent or good. Thirty per cent gave accountants an excellent rating.
* Accountants rated particularly well on the following attributes:
* the potential for a long-term relationship with the business (81% excellent/good)
* technical understanding of the regulatory requirements that apply to the business (79%)
* ability to meet the needs of the business (77%)
* understanding of the business of the SME and its operations (73%).

The survey of accounting practitioners produced the following information.
* The results indicate that SME firms with fewer than 10 employees are the main source of revenue for the respondent accounting practitioners.
* Virtually all accountants provide regulatory advice, primarily in the areas of taxation (particularly Goods and Services Tax, GST), and Do-It-      Yourself (DIY) superannuation requirements. These services provided the accountants with their largest business growth in the two years before the time of the survey.

Seventy-nine per cent of accountants referred their SME clients to external professional advisers. Their comments indicate (see Appendix 4) that some accountants consider their role to be as convenors or advisers for their SME clients. Importantly, according to the accountants, SME firms with fewer than 10 employees did not update their knowledge of regulatory requirements; they relied on their accountant for the right advice. The main types of external adviser to whom accountants referred their SME clients were lawyers and financial planners.

* Accountants expressed their concern regarding the complexity and amount of regulations affecting their SME clients.
* The accountants also stated that they would like to provide additional advice to their SME clients.
 
Confidence intervals – SME survey:  The survey sample size was 250 SMEs from the total of 1.2 million Australian SMEs. Any estimate of proportions agreeing or disagreeing with particular statements must be considered with respect to the margin of possible statistical error. Owing to the small sample size, generalising the results from this study to a wider population of SMEs may be constrained.

A 95% confidence interval of the sample mean for the following estimates based on a percentage agreement of 75% to a proposition with a sample size of 250 would be from 69.5% to 80.5%. The 95% confidence interval for estimates of any other value will diverge slightly in magnitude from the numbers given.

In general then we can be highly confident that the actual sample mean will be within approximately ± 5% of the figure given, with a survey of this size. Confidence intervals – acounting practitioner survey IBISWorld estimates reveal a figure of 9,222 accounting practices in Australia as at June 2006 (IBISWorld 2007). The sample size of 133 accounting practitioners gives a 95% confidence limit that the results reported from the mail-out survey are within the ± 5% confidence interval of the reported values.

Conclusions:  This report describes the results of two parallel surveys undertaken on the impact of business regulation on small and medium-sized enterprises in Australia and on the perceptions of accounting firms about the ways in which the regulatory impact on the SME sector drove their business.

The survey of SMEs provides empirical support for many of the concerns raised with the Regulation Taskforce, which reported to the Australian government in 2006. Many businesses are concerned about the volume and complexity of government legislation as it applies to their business. They are concerned that they are unable to keep up with new legislation and that there is apparent duplication of reporting requirements across the various tiers of government.

The survey of accountants revealed that accounting firms derive a significant proportion of their revenue from SMEs. While the SMEs are concerned with regulatory changes, the accountants surveyed reported that the major growth areas in their businesses were in what could be seen as traditional accounting areas of tax and superannuation. Some SMEs sought advice on areas such as employment law, environmental regulation and health and safety but it appears that many accountants refer their clients to specialists in these areas. Recent changes to the laws regarding financial planning in Australia may lead to changes in the market for financial advice in Australia, with many accountants apparently regarding this as a key driver of future business opportunities.

The surveys were conducted using a similar instrument to similar surveys conducted in the UK and Canada and reported in Blackburn et al. (2006). Comparisons of the Australian survey results with those from the UK and Canada seem to support the perception that Australian business is not over-regulated, but the SME sector is concerned with the volume and complexity of regulation. This suggests that the SME sector wants to see improvements to Australia’s regulatory regime as a result of the work of the Regulation Taskforce undertaken in 2005/6. In its response to the work of the Taskforce the government agreed with 158 of the 178 specific recommendations of the Taskforce. This now needs to be followed through at all levels of government.

Accountants in all three countries understand their SME clients’ concerns with the burden of regulation and they are prepared to advise their clients where appropriate or refer them to specialist advisers. Most business growth for accountants has come from the taxation area. Very few accountants in the UK or Australia specialise in providing advice in the areas of environmental regulation or health and safety regulation.

International comparisons show that in all three countries accountants are generally highly regarded by SMEs for their professionalism and competence. The major area of client concern is the value for money offered by the accountant’s service. In an era of rapidly shifting professional and technical boundaries, accountants need to be more strongly attuned to levels of client satisfaction. Lawyers, financial planners and a plethora of specialist advisers operate in the business services market and if they have an opportunity to take business from accountants by competing on price they may well do so. This suggests a stronger role for professional accounting bodies in monitoring the broader business services market for opportunities and threats on behalf of their membership.

Capacity building for the principalship : will leadership development solve the problem of principal disengagement?

This paper canvasses current proposals by Australian education departments for capacity building, school renewal, situated learning, resilience and ‘wellness’ in the Principalship, and the reflections and responses of current Principals.