Dimensions and reliability of a hospital safety climate questionnaire in Chinese health-care practice

The aim of the current study was to examine the dimensions and reliability of a hospital safety climate questionnaire in Chinese health-care practice. To achieve this, a cross-sectional survey of health-care professionals was undertaken at a university teaching hospital in Shandong province, China. Our survey instrument demonstrated very high internal consistency, comparing well with previous research in this field conducted in other countries. Factor analysis highlighted four key dimensions of safety climate, which centred on employee personal protection, employee interactions, safetyrelated housekeeping and time pressures. Overall, this study suggests that hospital safety climate represents an important aspect of health-care practice in contemporary China.

Improved rural health through a collaborative model of care – qualitative findings

INTRODUCTION Health disparity between urban and rural regions in Australia is well-documented. In the Wheatbelt catchments of Western Australia there is higher incidence and rate of avoidable hospitalisation for chronic diseases. Structured care approach to chronic illnesses is not new but the focus has been on single disease state. A recent ARC Discovery Project on general practice nurse-led chronic disease management of diabetes, hypertension and stable ischaemic heart disease reported improved communication and better medical administration.[1] In our study we investigated the sustainability of such a multi-morbidities general practice –led collaborative model of care in rural Australia. METHODS A QUAN(qual) design was utilised. Eight pairs of rural general practices were matched. Inclusion criteria used were >18 years and capable of giving informed consent, at least one identified risk factor or diagnosed with chronic conditions. Patients were excluded if deemed medically unsuitable. A comprehensive care plan was formulated by the respective general practice nurse in consultation with the treating General Practitioner (GP) and patient based on the individual’s readiness to change, and was informed by available local resource. A case management approach was utilised. Shediaz-Rizkallah and Lee’s conceptual framework on sustainability informed our evaluation.[2] Our primary outcome on measures of sustainability was reduction in avoidable hospitalisation. Secondary outcomes were patients and practitioners acceptance and satisfaction, and changes to pre-determined interim clinical and process outcomes. RESULTS The qualitative interviews highlighted the community preference for a ‘sustainable’ local hospital in addition to general practice. Costs, ease of access, low prioritisation of self chronic care, workforce turnover and perception of losing another local resource if underutilised influenced the respondents’ decision to present at local hospital for avoidable chronic diseases regardless. CONCLUSIONS Despite the pragmatic nature of rural general practice in Australia, the sustainability of chronic multi-morbidities management in general practice require efficient integration of primary-secondary health care and consideration of other social determinants of health. What this study adds: What is already known on this subject: Structured approach to chronic disease management is not new and has been shown to be effective for reducing hospitalisation. However, the focus has been on single disease state. What does this study add: Sustainability of collaborative model of multi-morbidities care require better primary-secondary integration and consideration of social determinants of health.

Expanded scope roles in primary health – what makes them work?

Introduction The demand for better integration between primary and secondary healthcare frequently leads to discussion about expanded scope of practice for nursing, paramedic and allied health professionals and the role these clinicians could play in facilitating improved access to timely and appropriate healthcare. From workforce perspective, expanded scope of practice has also been advocated as a mean of fostering workforce retention. Models of expanded scope roles in nursing and paramedicine have been trialled nationally and internationally in both acute and community care settings. Where they have been successful, trials have resulted in reduction in hospital presentation and admission; improved patient access and timeliness; and patient satisfaction. This paper will examine the characteristics of successful expanded scope programs. Method Exploratory case-study analysis of successful integration of expanded health care roles across primary healthcare settings in rural Australia. Results & Conclusions One size does not fill all. Successful models of integrated expanded health care roles in primary health care settings are built on stakeholder’s capacity and preference; community need; and political will. Collaborative, congruent, multi-disciplinary care teams that prioritise patient-centred care within a dynamic primary care setting have merit and are more likely to foster flexibility and sustainability.

A randomized controlled trial of self-management programme improves health-related outcomes of older people with heart failure

Aims This paper is a report on the effectiveness of a self-management programme based on the self-efficacy construct, in older people with heart failure. Background Heart failure is a major health problem worldwide, with high mortality and morbidity, making it a leading cause of hospitalization. Heart failure is associated with a complex set of symptoms that arise from problems in fluid and sodium retention. Hence, managing salt and fluid intake is important and can be enhanced by improving patients' self-efficacy in changing their behaviour. Design Randomized controlled trial. Methods Heart failure patients attending cardiac clinics in northern Taiwan from October 2006–May 2007 were randomly assigned to two groups: control (n = 46) and intervention (n = 47). The intervention group received a 12-week self-management programme that emphasized self-monitoring of salt/fluid intake and heart failure-related symptoms. Data were collected at baseline as well as 4 and 12 weeks later. Data analysis to test the hypotheses used repeated-measures anova models. Results Participants who received the intervention programme had significantly better self-efficacy for salt and fluid control, self-management behaviour and their heart failure-related symptoms were significantly lower than participants in the control group. However, the two groups did not differ significantly in health service use. Conclusion The self-management programme improved self-efficacy for salt and fluid control, self-management behaviours, and decreased heart failure-related symptoms in older Taiwanese outpatients with heart failure. Nursing interventions to improve health-related outcomes for patients with heart failure should emphasize self-efficacy in the self-management of their disease.

Re : Why optometry must work from urban and regional Aboriginal health services

We are writing to support the recent Viewpoint written by Anjou, Boudville and Taylor ‘Why optometry must work in Aboriginal Health Services in urban and regional Australia’.[1] We are a group of optometrists who provide optometric services within Aboriginal Health Services in urban and regional settings and we agree that access to optometry in Aboriginal Health Services should be supported and expanded in an effort to ‘close the gap’ for vision.

Sentencing policy : the politics of law and order

Against the advice of their own parliamentary committees, and despite the experience of other jurisdictions, both the Government and Opposition parties seem to be intent on outbidding each other on mandatory sentencing regimes in the lead-up to the 2003 NSW election, says DAVID BROWN.

The role of food regulation in promoting health

Food regulations are a series of laws and guidelines that focus on food that can be bought and sold in Australia. This system includes laws and regulations that address, food safety, food handling, what ingredients can go in a food, what a food can be called, what information needs to be included on a label, how a food can be advertised and promoted and developing a food industry that is both economically strong and supports the health of Australia's people and it's environment.

Proposing and developing a definition and conceptual framework for health care resilience to cope with disasters [Resiliencia: Propuesta y desarrollo de la definicion y del marco conceptual en relacion a los desastres en el ambito sanitario]

La creación del término resiliencia en salud es un paso importante hacia la construcción de comunidades más resilientes para afrontar mejor los desastres futuros. Hasta la fecha, sin embargo, parece que hay poca literatura sobre cómo el concepto de resiliencia en salud debe ser definido. Este artículo tiene como objetivo construir un enfoque de gestión de desastres de salud integral guiado por el concepto de resiliencia. Se realizaron busquedas en bases de datos electrónicas de salud para recuperar publicaciones críticas que pueden haber contribuido a los fines y objetivos de la investigación. Un total de 61 publicaciones se incluyeron en el análisis final de este documento, que se centraron en aquéllas que proporcionan una descripción completa de las teorías y definiciones de resiliencia ante los desastres y las que proponen una definición y un marco conceptual para la capacidad de resiliencia en salud. La resiliencia es una capacidad inherente de adaptación para hacer frente a la incertidumbre del futuro. Esto implica el uso de múltiples estrategias, un enfoque de riesgos máximos y tratar de lograr un resultado positivo a través de la vinculación y cooperación entre los distintos elementos de la comunidad. Resiliencia en salud puede definirse como la capacidad de las organizaciones de salud para resistir, absorber, y responder al impacto de los desastres, mientras mantiene las funciones esenciales y se recupera a su estado original o se adapta a un nuevo estado. Puede evaluarse por criterios como la robustez, la redundancia, el ingenio y la rapidez e incluye las dimensiones clave de la vulnerabilidad y la seguridad, los recursos y la preparación para casos de desastre, la continuidad de los servicios esenciales de salud, la recuperación y la adaptación. Este nuevo concepto define las capacidades en gestión de desastres de las organizaciones sanitarias, las tareas de gestión, actividades y resultados de desastres juntos en una visión de conjunto integral, y utiliza un enfoque integrado y con un objetivo alcanzable. Se necesita urgentemente investigación futura de su medición

The Politics and Legality of Prisoner Disenfranchisement in Australian Federal Elections

To remove the right of prisoners to vote does many things. … It signals that whatever the prisoner says is not of interest to those at the top, that you are not interested in talking to them or even listening to them, that you want to exclude them and that you have no interest in knowing about them. INTRODUCTION In June 2006, Australia passed legislation disenfranchising all prisoners serving full-time custodial sentences from voting in federal elections. This followed a succession of changes dating from 1983 that alternately extended and restricted the prisoner franchise. In 1989 and 1995, the Australian Labor Party (ALP) federal government prepared draft legislation removing any restrictions on prisoner voting rights in federal elections; the measures were defeated and withdrawn. With the 2006 legislation, the Howard Coalition government (composed of the Liberal and National parties) successfully achieved the total disenfranchisement it first sought in 1998. This chapter examines the politics and legality of the 2006 disenfranchisement. This will be approached, first, by briefly outlining the key provisions of the Commonwealth Electoral Act 1918, offering a short legislative history of prisoner franchise, and examining some of the key constitutional issues. Second, the 2006 disenfranchisement introduced in the Electoral and Referendum (Electoral Integrity and Other Measures) Act 2006 will be examined in greater detail, particularly in terms of the manner in which it was achieved and the arguments that were mobilized both in support of and against the change.

'Devils and dust' : extending the 'uncivil politics of law and order' to the 'war on terror'

The ‘war on terror’ and ongoing terrorist attacks around the world have generated a growing body of literature on national and international measures to counteract terrorist activity. This detailed study investigates an aspect of contemporary counter-terrorism that has been largely overlooked; the impact of these measures on the continued viability of the democratic state.