Measuring Scope of Practice Enactment among Primary Care Registered Nurses in Ontario

Background: Primary care is the sector of health care in which patients first establish contact with the health system, are provided person-focused care over time for all new or common needs, and receive coordinated integrated health services provided elsewhere by other members of the health care team. Registered Nurses (RNs) in Canada provide care within this sector in varying roles. The extent to which RNs enact their full scope of practice in primary care settings in Canada is not known. The Actual Scope of Practice questionnaire (ASCOP) is a 26 item Likert scale questionnaire developed by researchers in Canada and validated in the acute care setting to measure the extent to which RNs apply the knowledge, skills and competencies of the professional full scope of practice. Similar to the acute care setting, there is a need to measure scope of practice enactment in the primary care setting. Objectives: The overall aim of this thesis was to measure scope of practice enactment in the primary care setting. Two research objectives were addressed: (1) to revise and adapt the ASCOP questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument, the ASCOP-PC. Methods: To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective a cross-sectional survey of 178 RNs working in primary care organizations in Ontario was conducted Results: The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The ASCOP-PC yielded acceptable alpha coefficients ranging from 0.66 to 0.91 and explained variances from 44.2 to 62.6. Total mean score of 5.16 suggests that RNs within these models of care almost always engage in activities reflected in the ASCOP-PC. Interpretation: Findings from this study support the use of a the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care nurses in the primary care setting.

Crunch time for bank audits? Questions of practice and scope for dialogue

Purpose – The purpose of this paper is to review the way in which auditing issues have been raised and addressed during the credit crunch and developing global financial crisis. Design/methodology/approach – Analysis is based on a review of the academic auditing literature, regulatory and audit reports, together with papers from the financial press. Findings – After highlighting the relative lack of media attention devoted to the external auditing function in the light of major corporate collapses, the paper considers what, contrastingly, is an active and ongoing series of responses to the current crisis on the part of auditing firms and the profession more generally. Through such analysis the paper explores a number of implications of the credit crunch for both auditing practice and research. Research limitations/implications – The paper is constrained in part by the rapidly unfolding nature of events, with important policy developments arising almost on a daily basis. The paper draws primarily on events up to the beginning of October 2008. Practical implications – The paper has important messages for audit practice and research, including the technical capacities of external audits in the banking sector, the contributions of standard setting bodies and regulatory oversight, and the scope for enhanced dialogue between such parties and audit researchers. Originality/value - The paper serves both to focus and stimulate analysis of the credit crunch on the audit profession. It demonstrates the complexity of contemporary practice and highlights the importance, especially from an educational perspective, of developing understanding of banking audit practice and associated regulatory interactions – including the presented possibilities both for research and enhanced academic‐practitioner dialogue.

The legal framework for energy provisions in the European Union – With special regard to providing of energy provisions within the scope of Article 194(2) TFEU

The thesis interprets the caveat of Article 194(2) TFEU in order to assess the use of the Article as a legal basis for energy provisions provided by the European Union. The research subject is the Energy Title in the Treaty of the Functioning of the European Union and the possibilities of the application of the legal basis provided therein. The purpose is analysis of the possibilities for providing of provisions within the scope of the caveat found in Article 194(2) TFEU with special regard to the possibilities of providing renewable energy legislation. The purpose of the thesis is on one hand to provide an overview of the premises for providing of energy provisions in the EU, and on the other hand to analyse the Treaty text in order to determine the legal basis for energy provisions. The ultimate objective is to determine the correct legal basis for renewable energy provisions, aimed at the mitigation of climate change. According to Article 194(2) TFEU, the practice of the shared legislative powers in the field of energy are restricted by the retention of certain energy matters within the power of the Member States. The wording of the caveat containing the restrictions is open to interpretation and has been a subject of extensive discussion. Many scholars have argued that the caveat in Article 194(2) TFEU might obstruct decision-making in energy matters. This argument is contested, and the factual impact of the codification of the energy competences is analysed. The correct legal basis for energy provisions depends on the final interpretation of the text of the caveat and the level of significance of the effect of the measure. The use of Article 194(2) TFEU as a legal basis might not be the only option. There is a possibility that the legal bases within the Environmental Title might be used as legal bases for energy provisions in addition to Article 194(2) TFEU.

The legal framework for energy provisions in the European Union – With special regard to providing of energy provisions within the scope of Article 194(2) TFEU

The thesis interprets the caveat of Article 194(2) TFEU in order to assess the use of the Article as a legal basis for energy provisions provided by the European Union. The research subject is the Energy Title in the Treaty of the Functioning of the European Union and the possibilities of the application of the legal basis provided therein. The purpose is analysis of the possibilities for providing of provisions within the scope of the caveat found in Article 194(2) TFEU with special regard to the possibilities of providing renewable energy legislation. The purpose of the thesis is on one hand to provide an overview of the premises for providing of energy provisions in the EU, and on the other hand to analyse the Treaty text in order to determine the legal basis for energy provisions. The ultimate objective is to determine the correct legal basis for renewable energy provisions, aimed at the mitigation of climate change. According to Article 194(2) TFEU, the practice of the shared legislative powers in the field of energy are restricted by the retention of certain energy matters within the power of the Member States. The wording of the caveat containing the restrictions is open to interpretation and has been a subject of extensive discussion. Many scholars have argued that the caveat in Article 194(2) TFEU might obstruct decision-making in energy matters. This argument is contested, and the factual impact of the codification of the energy competences is analysed. The correct legal basis for energy provisions depends on the final interpretation of the text of the caveat and the level of significance of the effect of the measure. The use of Article 194(2) TFEU as a legal basis might not be the only option. There is a possibility that the legal bases within the Environmental Title might be used as legal bases for energy provisions in addition to Article 194(2) TFEU.

Rural and Isolated Practice Registered Nurse (RIPRN)-Emergency nurses of the Queensland `bush'

The Rural and Isolated practice endorsement for Queensland Registered Nurses has attracted interest from other state health authorities with respect to expanding the scope of practice of nurses working in rural and remote Australia. This discussion article outlines the endorsement program and sheds a spotlight on the program for the emergency and greater nursing community. The paper draws a similarity between rural and emergency nursing and stimulates the notion that other states could look to Queensland's model, for scope of practice expansion in other specialties such as emergency Nursing.

Management of orbitozygomatic fractures

Background: Management of orbitozygomatic fractures forms part of the scope of practice of many oral and maxillofacial Surgeons. As aspects of management vary among surgeons who treat such injuries, this confidential study was undertaken to examine some of the protocols of Australian and New Zealand oral and maxillofacial surgeons. Results: Eighty-one per cent of the respondents treated orbitozygomatic fractures and on average. each treated approximately 24 cases per year. Also, about one in five cases required orbital floor exploration. Further, the preferred imaging baseline was computed tomography plus plain X-rays. while the preferred implant materials for orbital floor reconstruction were autologous bone and resorbable membrane. The incidence of postoperative retrobulbar haemorrhage was estimated at approximately 1:1000. Conclusion: Most oral and maxillofacial surgeons treat orbitozygomatic injuries as part of their surgical scope.

Pro re nata medication for psychoses: an audit of practice in two metropolitan hospitals

Objective: To examine the use of pro re nata (PRN) (as needed) medication in hospitalized patients with psychotic disorders. Methods: Retrospective chart reviews were conducted at two large public psychiatry units situated in inner city general hospitals. Pro re nata medication prescription, administration and outcomes were examined during inpatient episodes of care for 184 consecutive admissions of patients diagnosed with a psychotic disorder. Patient demographics, diagnoses, and regularly prescribed medication were also recorded. All admissions were drawn from a three-month period from December 1998-February 1999. Results: The most prevalent diagnoses were schizophrenia related disorders (n = 111) and mania (n = 34). Substance use disorders (n = 49) were the most common comorbid dis-orders. Pro re nata medication was administered during the acute phase of 82% of admissions. Drugs prescribed Pro re nata were mostly typical antipsychotics, benzodiazepines and/or anti-cholinergics. Coprescription of typical antipsychotics PRN with regularly scheduled atypical antipsychotics was common (64%). Pro re nata medications accounted for 31% of the total antipsychotic dose and 28% of the total anxiolytic dose administered during acute treatment. Higher daily doses of PRN medication were given to manic patients, males, younger patients and those with substance use disorders. Pro re nata prescriptions usually specified a maximum daily dose (87%) but rarely gave indications for use (6%). Adminis-tration records frequently lacked a specified reason for use (48%) or a notation of outcome (64%). Unit staff noted medication-related morbidity in 37% of patients receiving PRN medication, compared to 3% of patients receiving only regularly scheduled medication. Extrapyramidal symptoms (EPS) were most frequently associated with administration of PRN haloperidol (Relative Risk vs other PRN medications = 5.61, 95% CI = 2.36-13.73). Conclusions: Pro re nata medications comprised a significant part of the treatment which psychotic patients received. The common practice of coprescribing PRN typical antipsychotics with scheduled atypical antipsychotics is potentially problematical since administration of PRN medication is associated with significant medication related morbidity. Preferential use of benzodiazepines as PRN agents may minimize this morbidity and foster subsequent compliance with regularly prescribed antipsychotics.