How do critical care nurses define the discharge planning process?

Background: Professional, political and organisational factors have focused attention on the discharge planning process in the Victorian health care sector. Discharge planning for patients, as part of continuity of care, is seen as a key concept in the delivery of nursing care. However, there is no question that discharge planning has emerged as a complex area of practice, and is, perhaps, most complex in the critical care area.

Aim: The study reported here is part of a larger thesis exploring critical care nurses’ perceptions and understanding of the discharge planning process in the health care system in the state of Victoria, Australia. As part of the survey participants were asked to define discharge planning as it related to the critical care environment in which they worked.

Methods: Utilising an exploratory descriptive approach, 502 Victorian critical care nurses were approached to take part in the study. The resultant net total of 218 participants completed the survey, which represented a net response rate of 43.4%. The data were analysed using quantitative and qualitative methodologies.

Findings: Three common themes emerged. A significant number of participants did not believe that discharge planning occurred in critical care, and therefore, thought that they could not provide a definition. There was uncertainty as to what the discharge planning process actually referred to in terms of discharge from critical care to the general ward or discharge from the hospital. There was an emphasis on movement of the patient to the general ward, which was considered in three main ways by first, getting the patient ready for transfer; second, ensuring a smooth transition to the ward and third, transfer of the patient to the ward often occurred because the critical care bed was needed for another patient.

Conclusion: The findings presented here suggest at a nursing level, the discharge planning process is not well understood and some degree of mutual exclusivity still remains. There is a need for further education of critical care nurses with regard to the underlying principles of the discharge planning process.

Critical care nurses' beliefs about discharge planning process: a questionnaire survey

Aim: To report on the beliefs of critical care nurses with regard to the discharge planning process, in Victoria, Australia.

Methods: An exploratory descriptive design was used. A total of 502 Victorian critical care nurses were approached to take part in the study. A total of 218 eligible participants completed the survey, which represented a nett response rate of 43.4%. The data were analysed using descriptive statistics.

Results: The current discharge planning processes are ad hoc and influenced by patient acuity. Critical care nurses believe that workload issues, unplanned discharges and inadequate communication contribute to difficulties implementing the discharge plan.

Financial planning education: turning intention into action

Most superannuation funds in Australia conduct seminars in financial literacy in the belief that they make a difference to their members when considering their retirement strategies. The investment intentions of seminar attendees was captured at the end of the seminar, and this was followed up three months later to see whether the intentions expressed at the end of the seminar had been implemented. The results were mixed, with expressed intentions not necessarily translating into action. The implications of this research is that while such seminars are valuable, they should be specifically targeted

Attaching unit costs to Australia`s national survey of mental health and wellbeing

Background: In mental health, policy-makers and planners are increasingly being asked to set priorities. This means that health economists, health services researchers and clinical investigators are being called upon to work together to define and measure costs. Typically, these researchers take available service utilisation data and convert them to costs, using a range of assumptions. There are inefficiencies, as individual groups of researchers frequently repeat essentially similar exercises in achieving this end. There are clearly areas where shared or common investment in the development of statistical software syntax, analytical frameworks and other resources could maximise the use of data.

Aims of the Study: This paper reports on an Australian project in which we calculated unit costs for mental health admissions and community encounters. In reporting on these calculations, our purpose is to make the data and the resources associated with them publicly available to researchers interested in conducting economic analyses, and allow them to copy, distribute and modify them, providing that all copies and modifications are available under the same terms and conditions (i.e., in accordance with the `Copyleft' principle). Within this context, the objectives of the paper are to: (i) introduce the `Copyleft' principle; (ii) provide an overview of the methodology we employed to derive the unit costs; (iii) present the unit costs themselves; and (iv) examine the total and mean costs for a range of single and comorbid conditions, as an example of the kind of question that the unit cost data can be used to address.

Method: We took relevant data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), and developed a set of unit costs for inpatient and community encounters. We then examined total and mean costs for a range of single and comorbid conditions.

Results: We present the unit costs for mental health admissions and mental health community contacts. Our example, which explored the association between comorbidity and total and mean costs, suggested that comorbidly occurring conditions cost more than conditions which occur on their own.

Discussion: Our unit costs, and the materials associated with them, have been published in a freely available form governed by a provision termed `Copyleft'. They provide a valuable resource for researchers wanting to explore economic questions in mental health.

Implications for Health Policies: Our unit costs provide an important resource to inform economic debate in mental health in Australia, particularly in the area of priority-setting. In the past, such debate has largely been based on opinion. Our unit costs provide the underpinning to strengthen the evidence-base of this debate.

Implications for Further Research: We would encourage other Australian researchers to make use of our unit costs in order to foster comparability across studies. We would also encourage Australian and international researchers to adopt the `Copyleft' principle in equivalent circumstances. Furthermore, we suggest that the provision of `Copyleft'-contingent funding to support the development of enabling resources for researchers should be considered in the planning of future large-scale collaborative survey work, both in Australia and overseas.

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.

A preliminary examination of public opinion in Australia on the use of biometric devices or identifiers in everyday life

Since the September 11,2001 terrorist attacks in New York City, many countries including Australia have been able to justify the use of biometric devices for identification and surveillance of their own citizens and others in the name of national security.

This paper reports on the preliminary findings of a survey that examined Australians' views and experiences with the use of biometric devices in everyday situations in the context of their potential to serve as a 'Panopticon' to keep the nation's citizenry under surveillance. It discusses the adoption of the new communication technology from the point of view of the Justification model that sees technology choice as social
gambling and the pluralist view of technology that sees technology as neutral in itself but as having negative or positive effects on society based on how It is used.

The paper proposes the need for Australian society to balance citizens' right to privacy and civil liberties with the right to stay alive and safe from terrorism and how it may be done with the necessary legal and regulator)' safeguards.

Technology and marginalization: a case study of the limited adoption of the intranet at a state-owned organisation in rural Australia

Taking a critical theory approach and the pluralist view of technology, this paper examines the problems in organizational communication that arose due to the implementation of a limited intranet electronic mail system as the main channel of communication between a rural stateowned organization and its city-based Head Office, installed at the sole discretion of the latter.
The intranet was provided only to the administration division and managers of some units due to financial constraints. This required others to receive information carried via the intranet through a gatekeeper who due to information and work overload, failed to disseminate the information effectively and efficiently. Using a combination of qualitative data collection methods, this study found that the intranet had marginalized those without access to it and reinforced the privileged position of those already with higher status within the organization, contrary to the utopian predictions
of new technologies as leading to social equality.

Organisational commitment of financial planners in Australia

The purpose of this paper is to determine whether the demographic variables of age, gender and length of service can be shown to be related to the organisational commitment (OC) of financial planners in Australia. The financial planners were surveyed using an instrument derived from established questionnaires. It was mailed nationally to 312 financial planners. A response rate of 36% was achieved, equating to 113 useable responses. The analyses revealed statistically significant results at the 90% confidence level (p=0.10), that respondents over the age of 35 demonstrated a significantly higher level of OC than did those under the age of 35, and at the same level of confidence, females demonstrated a statistically significant higher level of OC than did their male counterparts.

Such findings contribute to our understanding of the organisational commitment of Financial Planners, and have implications for employers in terms of hiring and retention of employees. The analyses are also important from a public policy perspective in an era of increasing attention given to, and likely increased regulation of, the financial planning industry.

The impact of enterprise resource planning systems on management accounting : an Australian study

Information technology is significantly changing the operating practices of an increasing number of companies globally. These developments have important implications for the accounting profession and in particular accounting practices in the twenty-first century. This study examines the development of enterprise resource planning (ERP) systems as a means of illustrating how changes in information technology allows all systems in a company to be linked to manage operations holistically.

The study investigates the change in accounting systems using a sample of Australian companies with emphasis on the adoption of ERP systems including the potential impact of ERP on capital budgeting processes. The results show that ERP systems are changing management accounting practices, although at this stage, the impact on capital budgeting techniques appears to be limited. The findings contribute to the emerging body of literature on the development of ERP systems and its impact on management accounting teaching and research.

How well do ecosystem-based planning units represent different componenets of biodiversity?

There are many proposals for managing biodiversity by using surrogates, such as umbrella, indicator, focal, and flagship species. We use the term biodiversity management unit for any ecosystem-based classificatory scheme for managing biodiversity. The sufficiency of biodiversity management unit classification schemes depends upon (1) whether different biotic elements (e.g., trees, birds, reptiles) distinguish between biodiversity management units within a classification (i.e., coherence within classes}; and (2) whether different biotic elements agree upon similarities and dissimilarities among biodiversity management unit classes (i.e., conformance among classes). Recent evaluations suggest that biodiversity surrogates based on few or single taxa are not useful. Ecological vegetation classes are an ecosystem-based classification scheme used as one component for biodiversity management in Victoria, Australia. Here we evaluated the potential for ecological vegetation classes to be used as biodiversity management units in the box-ironbark ecosystem of central Victoria, Australia. Eighty sites distributed among 14 ecological vegetation classes were surveyed in the same ways for tree species, birds, mammals, reptiles, terrestrial invertebrates, and nocturnal flying insects. Habitat structure and geographic separations also were measured, which, with the biotic elements, are collectively referred to as variables. Less than half of the biotic element-ecological vegetation class pairings were coherent. Generalized Mantel tests were used to examine conformance among variables with respect to ecological vegetation classes. While most tests were not significant, birds, mammals, tree species, and habitat structure together showed significant agreement on the rating of similarities among ecological vegetation classes. In this system, use of ecological vegetation classes as biodiversity management units may account reasonably well for birds, mammals, and trees; but reptiles and invertebrates would not be accommodated. We conclude that surrogates will usually have to be augmented or developed as hierarchies to provide general representativeness.

Cost of stroke in Australia from a societal perspective: results from the north east Melbourne stroke incidence study (NEMESIS)

Background and Purpose—— Accurate information about resource use and costs of stroke is necessary for informed health service planning. The purpose of this study was to determine the patterns of resource use among stroke patients and to estimate the total costs (direct service use and indirect production losses) of stroke (excluding SAH) in Australia for 1997.

Methods—— An incidence-based cost-of-illness model was developed, incorporating data obtained from the North East Melbourne Stroke Incidence Study (NEMESIS). The costs of stroke during the first year after stroke and the present value of total lifetime costs of stroke were estimated.

Results—— The total first-year costs of all first-ever-in-a lifetime strokes (SAH excluded) that occurred in Australia during 1997 were estimated to be A$555 million (US$420 million), and the present value of lifetime costs was estimated to be A$1.3 billion (US$985 million). The average cost per case during the first 12 months and over a lifetime was A$18 956 (US$14 361) and A$44 428 (US$33 658), respectively. The most important categories of cost during the first year were acute hospitalization (A$154 million), inpatient rehabilitation (A$150 million), and nursing home care (A$63 million). The present value of lifetime indirect costs was estimated to be A$34 million.

Conclusions—— Similar to other studies, hospital and nursing home costs contributed most to the total cost of stroke (excluding SAH) in Australia. Inpatient rehabilitation accounts for {approx}27% of total first-year costs. Given the magnitude of these costs, investigation of the cost-effectiveness of rehabilitation services should become a priority in this community.

Discharge planning: from the acute sector for people over the age of 65

This paper reports the findings relating to discharge planning from a larger study (Hegney et al 2001) that aimed to investigate options to improve care co-ordination between the aged, community, acute and primary care sectors for the elderly residents of a large provincial town. The data, which were collected from a wide variety of aged care stakeholders in the region, are consistent with previous Australian studies. First, it appears that inappropriate discharge from acute hospitals occurs in Toowoomba because there is a perceived lack of information regarding the available community care options and a lack of suitable models to support people's care needs within their own homes. Second, inappropriate discharge practices from acute hospitals occur due to a lack of knowledge and communication on the part of health professionals employed in these settings with regard to the on- going health care needs of elderly people. Third, there is little discharge planning occurring that includes the general practitioner in post-discharge care. Finally, inappropriate discharge can also be attributed to the lack of sub-acute/step-down/rehabilitation options and long waiting lists for community home care services in the region.