The initiation and administration of drugs for advanced life support by critical care nurses in the absence of a medical practitioner

Current legislation does not permit the administration of first line resuscitation medications by suitably qualified Division 1 registered nurses (RNs) in the absence of a medical officer. This omission by the Drugs,  Poisons and Controlled Substances Act 1981 (Vic) and the Drugs, Poisons and The Controlled Substances Regulations 1995 (Vic) leaves many critical care nurses in a vulnerable legal position.

The primary aim of this study was to gauge the view of critical care nurses with respect to lobbying for change to the current legislation. In addition, the study aimed to explore and describe the educational preparation, practice perceptions and experiences of RNs working in critical care regarding cardiopulmonary resuscitation and the administration of first line advanced life support (ALS) medications in the absence of a medical officer. It was anticipated that data collected would demonstrate some of the dilemmas associated with the initiation and administration of ALS medications for practising critical care nurses and could be used to inform controlling bodies in order for them to gain an appreciation of the issues facing critical care nurses during resuscitation.

A mailout survey was sent to all members of the Victorian Branch of the Australian College of Critical Care Nurses (ACCCN). The results showed that the majority of nurses underwent an annual ALS assessment and had current ALS accreditation. Nurses indicated that they felt educationally prepared and were confident to manage cardiopulmonary resuscitation without a medical officer; indeed, the majority had done so. The differences in practice issues for metropolitan, regional and rural nurses were highlighted. There is therefore clear evidence to suggest that legislative amendments are appropriate and necessary, given the time critical nature of cardiopulmonary arrest. There was overwhelming support for ACCCN Vic. Ltd to lobby the Victorian government for changes to the law.

Just deserts in post-colonial society : problems in the punishment of indigenous offenders.

Revised version of a paper presented to the Australian and New Zealand Society of Criminology Conference, Sydney, 2-3 October 2003 - disproportionate number of indigenous persons in the criminal justice system - the concept of 'just deserts' in regard to indigenous punishment - legislative reforms are needed to empower the judiciary in the sentencing process - must take account of the historical fact of dispossession - destructive effects on indigenous communities.

Staging modernity: the Semarang international colonial exhibition, 1914

The international exhibitions of the late nineteenth and early twentieth centuries are now generally seen as sites for the dissemination of an evolving discourse on modernity's primary theme: progress. These technological and cultural spectacles represented 'the self-congratulatory pride' of the bourgeoisie in their attainment of world power (Corbey 1994:60). The didactic function of international exhibitions lay embedded in their carefully arranged, itemised and annotated displays, as well as in the very architecture within which such displays were housed. It was a pedagogy palely echoed in every elementary classroom and school textbook of the newly created mass education systems of the day (Cote 2000a). The exhibitions were also modern in their embrace of the mass audience and their intentionally populist focus. An exhibition was intended to provide the visitor, already touched by a modern curiosity, with personal access to the wonders of modernity.

The effects of specific educational preparation on emergency nurses` clinical decisions regarding supplemental oxygen administration

Abstract The use of supplemental oxygen by emergency nurses has important implications for patient outcomes, yet there is significant variability in oxygen administration practises. Specific education related to oxygen administration increases factual knowledge in this domain; however, the impact of knowledge acquisition on nurses' clinical decisions is poorly understood. This study aimed to examine the effect of educational preparation on 20 emergency nurses' decisions regarding the assessment of oxygenation and the use of supplemental oxygen. A pre-test/post-test, quasi-experimental design was used. The intervention was a written, self-directed learning package. The major effects of the completion of the learning package included no change in the number or types of parameters used by nurses to assess oxygenation, a significant decrease in the selection of simple masks, a significant increase in the selection of air entrainment masks, fewer hypothetical outcomes of unresolved respiratory distress and more hypothetical outcomes of decreased respiratory distress. As many nursing education programs are aimed at increasing factual knowledge, while experience remains relatively constant, a greater understanding of the relationship between factual knowledge and clinical decisions is needed if educational interventions are to improve patient outcomes.

Modelling and Administration of Contract-Based Systems

Mirroring the paper versions exchanged between businesses today, electronic contracts offer the possibility of dynamic, automatic creation and enforcement of restrictions and compulsions on agent behaviour that are designed to ensure business objectives are met. However, where there are many contracts within a particular application, it can be difficult to determine whether the system can reliably fulfil them all; computer-parsable electronic contracts may allow such verification to be automated. In this paper, we describe a conceptual framework and architecture specification in which normative business contracts can be electronically represented, verified, established, renewed, etc. In particular, we aim to allow systems containing multiple contracts to be checked for conflicts and violations of business objectives. We illustrate the framework and architecture with an aerospace example.

Educational administration and social justice

After observing that texts in educational administration have largely failed to address the problem of the justice and fairness of social and educational arrangements, this article goes on to examine the necessary relationships between ethical leadership, community and the notion of social justice. Such relationships are argued to be necessarily political, although the field of leadership has historically seen administration as a substitute for politics. The relationship between social justice and disadvantage is examined, as are current approaches to community, choice and diversity. The importance of both redistributive and recognitional approaches to social justice is emphasized as a basis for a model of educational administration centred on the problem of the justice and fairness of social and educational arrangements.

Culture and leadership in educational administration: a historical study of what was and what might have been

This paper examines the consequences for school leadership of the abandonment of Waller's insights into the school as a social organism and the embracing of the cult of efficiency as the foundation for the analysis of school culture. Tracing the separation of conception from execution, leadership from teaching, administration from education through the cult of professionalism and functionalist sociology, the paper argues that a more appropriate basis for understanding both leadership and the culture of the school can be derived from ethnographies of schooling which show the complex interactions of internal and external cultures in the construction of leadership and the culture of the school.

Colonial designs: Thomas Karsten and the planning of urban Indonesia

Thomas Karsten (1885 – 1945) is undoubtedly a major figure in the history of architecture and town planning in Indonesia. Between 1915 and 1941 he was involved in town planning in 12 of the 19 municipalities and towns in Java (the most prominent exception being Surabaya) 3 of the 9 towns in Sumatra, and the only town in Borneo This paper does not attempts to investigate or question his importance in this field but to place his architectural and town planning ideas in the context of his broader politico-cultural ideas and activities in the Dutch East Indies between 1914 and 1942, and these, in turn, in the context of an evolving colonialism and colonial discourse.

Medication management by graduate nurses: before, during and following medication administration

The purpose of the present study was to explore graduate nurses' perceptions of their medication management activities in the acute care context. A qualitative research design with a semistructured interview schedule was used to elicit information from participants. The sampling population consisted of graduate nurses involved in direct patient care in medical and surgical wards of a Melbourne metropolitan teaching hospital, completing a graduate nurse program. Twelve graduate nurses participated in the interviews. Two major themes emerged: (i) monitoring medications and (ii) interventions for patient care. The findings indicate that graduate nurses are required to address several facets of the medication management role in their daily practice. It is pertinent to examine ward dynamics to ensure that graduate nurses have ready access to experienced health care professionals. Through collegial support, graduate nurses should also be encouraged to critically examine the different possibilities when making clinical judgments about monitoring patient medications.

Reconciling colonial memories in Korea and Japan

The Republic of Korea and Japan share a tumultuous history, but arguably no period has caused greater trauma in bilateral relations than the twentieth century. After Japan’s four-decade long colonial occupation of Korea, the two countries took two decades just to establish diplomatic relations. Subsequent interactions have remained seriously compromised by the memory of colonialism. This article reviews the tensions behind the tempestuous bilateral relationship, focusing on the depiction of Japan’s wartime past in school textbooks. We advance three suggestions for reconciliation: viewing reconciliation not as the restoration of a harmonious pre-conflict order, but as an ongoing, incomplete process; expanding promising bilateral dialogues; and accepting that there will always be differences between Korea and Japan, most notably with regard to representations of the past. Rather than being an inevitable source of conflict, these differences should contribute to an ongoing process of negotiation between the two neighbors.

Nurses' reassessment of postoperative pain after analgesic administration

Objectives: To identify when and how nurses reassess patients' pain after analgesic administration in the postoperative context.
Methods: Fifty-two nurses were observed caring for postoperative patients (N = 364) in 2 surgical settings in a major metropolitan hospital. Seventy-four observation periods of 2 hours duration were studied. The research assistant observed nurses' activities in caring for the allocated patients'. detailing behavioral and verbal responses onto audiotape.
Results: Of the 316 pain activities Ihat occurred in 74 observation periods. 14 (4.4%) were reassessments after analgesic administration. Four themes were evident from the 14 reassessments: opportunistic reassessment. the use of simple questioning, a focus on surgical wound pain not procedural
pain, and nurse-initiated reassessment.
Conclusions: Despite the focus on meeting standards of care in the area of pain management, there was an extraordinary lack of patient reassessment by nurses after the administration of analgesics. Given Ihe raised awareness internationally on assessment generally and a lack of evidence focused on reassessment after an intervention, this may explain why research is failing to identify shifts in pain severity scores and indeed patient pain.

Self-administration of medication in hospital: patients' perspectives

Background. Little information is available about patients' perspectives on self- or nurse-related administration of medication.

Aim. The aim of the study was to determine patients' perspectives about self-medication in the acute care setting.

Methods. A qualitative approach, using in-depth semi-structured interviews, was taken. Ten patients with a chronic medical illness who had experienced multiple hospital admissions for treatment were interviewed about their experiences of medication administration in the acute care setting. Participants were recruited from two cardiovascular wards in a private, not-for-profit hospital in Melbourne, Australia. Data collection occurred between August and September 2002.

Findings. Four major themes were identified from the interviews: benefits of self-administration, barriers to self-administration, assessing appropriateness of self-administration and timing of medication administration. Seven participants had previously experienced self-administration of medications and six were in favour of this practice in the clinical setting. Nine managed their own medications at home, and one self-administered with some assistance from his family. Participants were very concerned about how nurses' heavily regulated routines affected delivery of medications in hospital and disrupted individualized plans of care maintained in the home setting.

Conclusions. In planning and implementing self-administration programmes, it is important to consider patients' views. Medication regimes should be simple and flexible enough to adapt to patients' lifestyles and usual routines. Nurses should also take advantage of opportunities to support and facilitate patient autonomy, to enable more effective management of health care needs when patients return home.

Recalling the Indies : colonial culture & postcolonial identities

Recalling the Indies traces the life stories of former residents of the Dutch East Indies, the present-day Republic of Indonesia. These stories belong to people of Dutch and mixed Indonesian and European descent and traces their lives, their exodus from the Indonesian archipelago, and their journey to Australia. Very little of the history of the Indisch Dutch has appeared in the English language. Underlying the entire book is the interest in "History" and historical writing.