Nurse stress in hospital and satellite haemodialysis units

Focus groups of nurses from both in-centre and satellite dialysis units were undertaken followed by questionnaires. The In-centre nursing staff rated the busy-ness of the unit as the maximum stress. The mostly notable stressor for the staff at the satellite unit related to patient behaviour and the perceived unrealistic expectations of the patient followed by patients arriving unwell at the unit.

Nurses suffer stress on a daily basis in both in-centre and satellite dialysis units. The major stressors differ from in-centre to satellite dialysis units.

Study into the ultrasonic cleaning of wool

This research studied the use of ultrasonic irradiation during wool cleaning with an aim to improve the cleaning process and reduce its impact on the environment. The research found that ultrasonic cleaning reduced energy, detergent and chemicals consumption, reduced fibre entanglement and had no significant effect on fibre properties.

Small rural hospital emergency department database

This data includes activity and performance data from the emergency departments at the local hospitals (Rural Category Three Public Health Services) in the Southwest region of Victoria.

Effect of operating parameters and cleaning on the performance of ceramic membranes treating partially clarified sugar cane juice

The performance of ceramic membranes with pore sizes of 0.05 and 0.10 mm in purifying limed and partially clarified sugar cane juice was investigated under different operating conditions. From various operating conditions and strategies, switching off the permeate for 5 seconds for every 5 minutes (S5sT5 m) by an automated control valve provided higher flux. From the three pH experiments conducted on the 0.05 mm membrane, the best performance was observed at a pH of 7.5. Amongst the four fouling models tested, the cake filtration model fitted the performance of both membranes with higher accuracy at a transmembrane pressure of 0.5 bar. Filtering the cane juice through the membrane reduced the turbidity by 99.7%, color by 15%, and the starch concentration by 80% as well as increased the purity by 1.4%. The effective cleaning chemical composition from experimental results showed that 1% NaOH and 3000 ppm NaOCl solution performed the best but only for the experiments that were treating limed and partially clarified juice at pH 7.5.

Restructuring the architecture of state regulation in the Australian and Aotearoa/New Zealand cleaning industries and the growth of precarious employment

This paper examines changes in the commercial cleaning industry in Australasia which are occurring against a backdrop of significant transformation in the mode of labour market regulation in both countries. Specifically, whereas for most of the twentieth century both Aotearoa/New Zealand and Australia had systems of labour market regulation in which the state provided minimum wage and work protections through the interventions of arbitration courts, in the past few years these courts have either been abolished (in the case of New Zealand) or severely restricted in their ambit (in the case of Australia), all as part of a neoliberal effort to introduce “flexibility” into labour markets. The result has been an erosion of wages and a worsening of conditions of employment for cleaners and many other groups of workers. At the same time, this transformation in the architecture of labour market regulation poses significant challenges to unions seeking to represent cleaners and other low-paid service sector workers.

On the mopfloor: researching employment relations in the hidden world of commercial cleaning

This chapter explores some of the challenges and tribulations of studying the hidden and hitherto unresearched world of work in the New South Wales (Australia) cleaning industry. The findings and analysis presented here are informed by my research into employment relations, labour management and the organisation of work in the NSW commercial cleaning industry (Ryan, 2007). This research used primarily a case study of an industry exemplar, and made extensive use of participant observation to obtain evidence on the perceived realities of work and organisation for those on the front line of cleaning work - the cleaners and their supervisors - and to understand how they make sense of their working world. The discussions and findings presented in this chapter support the use of an ethnographic approach to work, and provide some guidance as to how a participant observation study might be carried out and what might be found through the use of this method.

Team clinical supervision in acute hospital wards : a feasibility study

Clinical supervision provides a strategy to mitigate nurses’ workplace stress and enhance retention, but the literature provides little guidance about its implementation beyond mental health nursing. This study explored the feasibility of implementing and evaluating ward-based team clinical supervision for general nurses on two separate wards at one public and one private hospital. Nurses completed the Work Environment Questionnaire pre- (n = 36) and post intervention (n = 27), and focus groups (n = 20) explored their perceptions of supervision. Staff were unfamiliar with clinical supervision, so information sessions were required. The questionnaire may not have been suitable to evaluate this type of intervention. Focus group findings revealed that team supervision improved communication, enhanced working relationships, and empowered nurses to challenge existing practices, which had a positive impact on their perceived stress. This study provides insights to guide implementation and evaluation of clinical supervision in acute settings.

Hospital malnutrition : prevalence, identification and impact on patients and the healthcare system

Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay, higher treatment costs and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. Nutrition risk screening using a validated tool is a simple technique to rapidly identify patients at risk of malnutrition, and provides a basis for prompt dietetic referrals. In Australia, nutrition screening upon hospital admission is not mandatory, which is of concern knowing that malnutrition remains under-reported and often poorly documented. Unidentified malnutrition not only heightens the risk of adverse complications for patients, but can potentially result in foregone reimbursements to the hospital through casemix-based funding schemes. It is strongly recommended that mandatory nutrition screening be widely adopted in line with published best-practice guidelines to effectively target and reduce the incidence of hospital malnutrition.

Early predictors of hospital admission in emergency department patients with chronic obstructive pulmonary disease

Background: Streamlining emergency department (ED) care of patients with chronic obstructive pulmonary disease (COPD) may be an important strategy in managing the increasing burden of this disease.

Study objectives: The aim of this study was to identify factors predictive of hospital admission in ED patients with COPD, specifically factors that can be used early in the ED episode of care.

Methods: Using retrospective regression analysis, case data from 321 randomly selected medical records from five Australian EDs were analysed. Patient characteristics, triage and ED system features, physiological status, and ED treatment during the first four hours of ED care were compared between discharged and admitted patients.

Results: Factors available on ED arrival associated with increased likelihood of admission were: age (OR = 1.04, p = 0.008) respiratory symptoms affecting activities of daily living (OR = 1.8, p = 0.043) and signs of respiratory dysfunction (OR = 2.5, p = 0.005). Factors available from the first four hours of ED care associated with increased likelihood of admission were: age (OR = 1.04, p = 0.021), oxygen use at four hours (OR = 3.5, p = 0.002) and IV antibiotic administration (OR = 2.6, p = 0.026). There were conflicting findings regarding the association between ambulance transport and admission.

When is a team a team? 'Teamworking' and the reorganisation of work in commercial cleaning

Purpose – The article seeks to analyse and explore the contradictions and variations in the concepts “team” and “teamwork” and their use in the NSW, Australia, commercial cleaning industry.

Design/methodology/approach – The article utilises an ethnographic study of a large Australian cleaning firm. Data were collected using participant observation, field notes, and interviews with managers.

Findings – The study provides evidence for the limited uptake of the idealised form of teamwork in commercial cleaning and suggests that teamworking is another means of coordinating groups of workers. Furthermore, the findings support previous research into the paradox of teams without teamwork.

Originality/value – The research provides an insight into the largely neglected area of the reorganisation of work in commercial cleaning. It also provides a critique of the concept of teams and teamworking.

Effectiveness of pain management in hospital in the home programs

Objectives: The objective of the study was to examine patients’ experiences of pain in Hospital in the Home (HITH) programs and
identify the issues related to providing optimal pain management for acute care patients in the home environment.
Methods: A descriptive survey of patients’ experience of pain and pain management in 3 HITH programs in metropolitan Melbourne,
Australia (n=359). Data were collected by telephone interview using a modified version of The American Pain Society’s Patient Outcome Questionnaire. Patients were interviewed 48 to 72 hours after admission to the HITH program. Consecutive, adult, acute care patients were invited to participate in the study. Patients who had previously participated or had communication difficulties unable to be overcome with the assistance of an interpreter were excluded.
Results: Sixty-nine percent of patients interviewed experienced pain at home and 86% of these patients had experienced pain in the 24 hours before the interview. Over half (56%) of the patients had experienced moderate-to-severe worst pain in the previous 24 hours and 33% reported moderate-to-severe pain as their average pain experience. Two hundred thirty-two (93.2%) of the 250 patients who experienced pain had pain in hospital before being transferred to HITH. Of these patients, 52.2% (n=132) were prescribed analgesics to take home with them; the remaining 118 patients experiencing pain were not prescribed analgesics and either sourced analgesics once home (n=81, 68.1%) or did not take any analgesics (n=38, 31.9%).
Discussion: Treatment of pain at home was suboptimal with patients experiencing moderate-to-severe pain and discomfort during the treatment phase of their illness. Lack of appropriate discharge planning strategies meant that patients went home without adequate analgesia and use of non prescribed pain medication was common. The number of patients transferred home without analgesics indicates a worrying under recognition of the need for analgesia in this care context and poses a risk to patient safety that is no less significant because patients are at home.