Dissertations / Theses: 'Australian health care'

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Grace, Sandra. "Integrative Medicine in Contemporary Australian Health Care." Thesis, The University of Sydney, 2008. http://hdl.handle.net/2123/4048.

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ABSTRACT Integrative medicine (IM) is a dynamic and increasingly prevalent model of primary health care that combines complementary and alternative medicine with mainstream medicine. This research is about the practice of IM and its value to primary health care in Australia. It locates IM within Australian health care by revealing its processes and outcomes in terms of: practice styles, interactions between practitioners and clients and among practitioners, range of diagnostic and treatment options, and health benefits. In this research I examine the nature of integrative medicine (IM) in co-located primary health care practices and consider the influence that integrating mainstream medicine and CAM can have on the perceived quality of primary health care in Australia. My goal was to contribute the knowledge of the phenomenon of IM through a deeper understanding and interpretation of IM gained by investigating the perceptions of core stakeholders, in this case clients and practitioners of IM. This research was situated in the interpretive paradigm and used two research methodologies: hermeneutics (to interpret the value of IM as reported in the literature) and hermeneutic phenomenology (to understand meanings and significance that clients and practitioners attach to their experiences of IM). Data collection involved the collation of existing literature texts and by cumulative case studies (using semi-structured interviews and observation), focus groups, and key informant interviews. Using a blend of methodologies provided a rich and powerful means of understanding the processes and outcomes of IM through the interpretations of its core stakeholders’ lived experiences. In particular I sought perceptions of clients and practitioners of IM about their health and health care including assessment and treatment options, health outcomes, congruence with beliefs and values, collaborative practices and power sharing. Data analysis was conducted concurrently with and subsequent to data collection so that questioning, observation and textual interpretation were progressively guided by the data. A set of meta-themes emerged from the fusion of findings from all phases of the research. These meta-themes represented answers to key research questions. They are: • Power/authority • Mutual respect • Professionalism • Ontological perspectives • Duty of care. This thesis identifies IM practice styles according to different levels of client agency and degrees of power sharing that exist among CAM and mainstream medical practitioners. A theorised model based on the research findings which depicts quality of health care as a variable consequence of diverse practice styles of IM is produced in two parts: Part 1 acknowledges that IM is a variable phenomenon in practice with different levels of collaboration, power-sharing and quality of health care; Part 2 presents an optimum mode of IM practice. Authentically client-centred health care is at the core of all of these practice styles. This thesis has significant implications for the way IM is practised and for primary health care delivery more broadly. IM that is mutually respectful and genuinely collaborative is flexible, inclusive, and socially relevant and has a substantial and far-reaching contribution to make to the quality of primary health care.

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Grace, Sandra. "Integrative Medicine in Contemporary Australian Health Care." Faculty of Health Sciences, The University of Sydney, 2008. http://hdl.handle.net/2123/4048.

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Doctor of Philosophy
ABSTRACT Integrative medicine (IM) is a dynamic and increasingly prevalent model of primary health care that combines complementary and alternative medicine with mainstream medicine. This research is about the practice of IM and its value to primary health care in Australia. It locates IM within Australian health care by revealing its processes and outcomes in terms of: practice styles, interactions between practitioners and clients and among practitioners, range of diagnostic and treatment options, and health benefits. In this research I examine the nature of integrative medicine (IM) in co-located primary health care practices and consider the influence that integrating mainstream medicine and CAM can have on the perceived quality of primary health care in Australia. My goal was to contribute the knowledge of the phenomenon of IM through a deeper understanding and interpretation of IM gained by investigating the perceptions of core stakeholders, in this case clients and practitioners of IM. This research was situated in the interpretive paradigm and used two research methodologies: hermeneutics (to interpret the value of IM as reported in the literature) and hermeneutic phenomenology (to understand meanings and significance that clients and practitioners attach to their experiences of IM). Data collection involved the collation of existing literature texts and by cumulative case studies (using semi-structured interviews and observation), focus groups, and key informant interviews. Using a blend of methodologies provided a rich and powerful means of understanding the processes and outcomes of IM through the interpretations of its core stakeholders’ lived experiences. In particular I sought perceptions of clients and practitioners of IM about their health and health care including assessment and treatment options, health outcomes, congruence with beliefs and values, collaborative practices and power sharing. Data analysis was conducted concurrently with and subsequent to data collection so that questioning, observation and textual interpretation were progressively guided by the data. A set of meta-themes emerged from the fusion of findings from all phases of the research. These meta-themes represented answers to key research questions. They are: • Power/authority • Mutual respect • Professionalism • Ontological perspectives • Duty of care. This thesis identifies IM practice styles according to different levels of client agency and degrees of power sharing that exist among CAM and mainstream medical practitioners. A theorised model based on the research findings which depicts quality of health care as a variable consequence of diverse practice styles of IM is produced in two parts: Part 1 acknowledges that IM is a variable phenomenon in practice with different levels of collaboration, power-sharing and quality of health care; Part 2 presents an optimum mode of IM practice. Authentically client-centred health care is at the core of all of these practice styles. This thesis has significant implications for the way IM is practised and for primary health care delivery more broadly. IM that is mutually respectful and genuinely collaborative is flexible, inclusive, and socially relevant and has a substantial and far-reaching contribution to make to the quality of primary health care.

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MURPHY, CATHRYN LOUISE School of Health Services Management UNSW. "INFECTION CONTROL IN THE AUSTRALIAN HEALTH CARE SETTING." Awarded by:University of New South Wales. School of Health Services Management, 1999. http://handle.unsw.edu.au/1959.4/17600.

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1,708 members of the Australian Infection Control Association were surveyed to describe the practices of Australian infection control practitioners. The study details the methods infection control practitioners use to co-ordinate and measure nosocomial infections as clinical outcomes of Australian infection surveillance and control programs. Administrators' and clinicians' perceptions of the elements and infrastructure of infection surveillance and control programs and the role of the infection control were measured in 316 hospitals in New South Wales, Australia. A literature review found that the development of Australian infection surveillance and control programs is behind that of U.S.A and the United Kingdom. The survey of the infection control practitioners identified that their role and duties varied between facilities as did the time allocated to infection control tasks. The survey of infection control practitioners demonstrated variation in their levels of skill, education and experience. Infection control practitioners' use and application of evidence and associated skills was examined and found to be limited in relation to clinical decision making and policy development. The survey also examined the methods infection control practitioners use to undertake surveillance of nosocomial infections. The methods reported indicated non-standard approaches to surveillance activity. A survey of administrators and clinicians in NSW hospitals was undertaken to identify variation in administrator and clinician perceptions and to describe their level of support for recommended essential infrastructure and criteria for infection surveillance and control programs and the role of the infection control practitioner in accordance with Scheckler's model. The survey indicated divergent views regarding the role of the infection control practitioner and the essential elements of infection surveillance and control programs. The study identified that education of infection control practitioners is necessary to facilitate standard approaches to co-ordinating infection surveillance and control activity. The development of Australian infection surveillance and control programs require a strategic alliance between stakeholders. to define essential elements of infection surveillance and control programs. In addition, the role of the infection control practitioner must be defined before key stakeholders can agree on the minimum skills, qualifications and experience required by an infection control practitioner.

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Badrick, Tony Cecil. "Implementing total quality management in Australian health care organizations." Thesis, Queensland University of Technology, 1997.

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McCabe, Helen, and res cand@acu edu au. "The Ethical Implications of Incorporating Managed Care into the Australian Health Care Context." Australian Catholic University. School of Philosophy, 2004. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp48.29082005.

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AIMS Managed care is a market model of health care distribution, aspects of which are being incorporated into the Australian health care environment. Justifications for adopting managed care lie in purported claims to higher levels of efficiency and greater ‘consumer’ choice. The purpose of this research, then, is to determine the ethical implications of adapting this particular administrative model to Australia’s health care system. In general, it is intended to provide ethical guidance for health care administrators and policy-makers, health care practitioners, patients and the wider community. SCOPE Managed care emerges as a product of the contemporary, neo-liberal market with which it is inextricably linked. In order to understand the nature of this concept, then, this research necessarily includes a limited account of the nature of the market in which managed care is situated and disseminated. While a more detailed examination of the neo-liberal market is worthy of a thesis in itself, this project attends, less ambitiously, to two general concerns. Firstly, against a background of various histories of health care distribution, it assesses the market’s propensity for upholding the moral requirements of health care distributive decision-making. This aspect of the analysis is informed by a framework for health care morality the construction of which accompanies an inquiry into the moral nature of health care, including a deliberation about rights-claims to health care and the proper means of its distribution. Secondly, by way of offering a precautionary tale, it examines the organisational structures and regulations by which its expansionary ambitions are promoted and realised. CONCLUSIONS As a market solution to the problem of administering health care resources, the pursuit of cost-control, if not actual profit, becomes the primary objective of health care activity under managed care. Hence, the moral purposes of health care provision, as pursued within the therapeutic relationship and expressed through the social provision of health care, are displaced by the economic purposes of the ‘free’ market. Accordingly, the integrity of both health care practitioners and communities is corrupted. At the same time, it is demonstrated that the claims of managed care proponents to higher levels of efficiency are largely unfounded; indeed, under managed care, health care costs have continued to rise. At the same time, levels of access to health care have deteriorated. These adverse outcomes of managed care are borne, most particularly, by poorer members of communities. Further, contrary to the claims of its proponents, choice as to the availability and kinds of health care services is diminished. Moreover, the competitive market in which managed care is situated has given rise to a plethora of bankruptcies, mergers and alliances in the United States where the market is now characterised by oligopoly and monopoly providers. In this way, a viable market in health care is largely disproved. Nonetheless, when protected within a non-market context and subject to the requirements of justice, a limited number of managed care techniques can assist Australia’s efforts to conserve the resources of health care. However, any more robust adoption of this concept would be ethically indefensible.

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McCabe, Helen Mary. "The ethical implications of incorporating managed care into the Australian health care context." Phd thesis, Australian Catholic University, 2004. https://acuresearchbank.acu.edu.au/download/d50b168254fc36e931bd3b650cbb4c07af91aa95b70a93080a6ccdbd53a2d651/2401581/64983_downloaded_stream_208.pdf.

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AIMS Managed care is a market model of health care distribution, aspects of which are being incorporated into the Australian health care environment. Justifications for adopting managed care lie in purported claims to higher levels of efficiency and greater 'consumer' choice. The purpose of this research, then, is to determine the ethical implications of adapting this particular administrative model to Australia's health care system. In general, it is intended to provide ethical guidance for health care administrators and policy-makers, health care practitioners, patients and the wider community. SCOPE Managed care emerges as a product of the contemporary, neo-liberal market with which it is inextricably linked. In order to understand the nature of this concept, then, this research necessarily includes a limited account of the nature of the market in which managed care is situated and disseminated. While a more detailed examination of the neo-liberal market is worthy of a thesis in itself, this project attends, less ambitiously, to two general concerns. Firstly, against a background of various histories of health care distribution, it assesses the market's propensity for upholding the moral requirements of health care distributive decision-making. This aspect of the analysis is informed by a framework for health care morality the construction of which accompanies an inquiry into the moral nature of health care, including a deliberation about rights-claims to health care and the proper means of its distribution. Secondly, by way of offering a precautionary tale, it examines the organisational structures and regulations by which its expansionary ambitions are promoted and realised. CONCLUSIONS As a market solution to the problem of administering health care resources, the pursuit of cost-control, if not actual profit, becomes the primary objective of health care activity under managed care.;Hence, the moral purposes of health care provision, as pursued within the therapeutic relationship and expressed through the social provision of health care, are displaced by the economic purposes of the 'free' market. Accordingly, the integrity of both health care practitioners and communities is corrupted. At the same time, it is demonstrated that the claims of managed care proponents to higher levels of efficiency are largely unfounded; indeed, under managed care, health care costs have continued to rise. At the same time, levels of access to health care have deteriorated. These adverse outcomes of managed care are borne, most particularly, by poorer members of communities. Further, contrary to the claims of its proponents, choice as to the availability and kinds of health care services is diminished. Moreover, the competitive market in which managed care is situated has given rise to a plethora of bankruptcies, mergers and alliances in the United States where the market is now characterised by oligopoly and monopoly providers. In this way, a viable market in health care is largely disproved. Nonetheless, when protected within a non-market context and subject to the requirements of justice, a limited number of managed care techniques can assist Australia's efforts to conserve the resources of health care. However, any more robust adoption of this concept would be ethically indefensible.

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Lansingh, Van Charles. "Primary health care approach to trachoma control in Aboriginal communities in Central Australia." Connect to thesis, 2005. http://repository.unimelb.edu.au/10187/984.

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This study concerned a primary health care approach to trachoma control in two Central Australian Aboriginal communities. The World Health Organization (WHO) has advocated that the best method to control trachoma is the SAFE strategy (Surgery, Antibiotics, Facial hygiene, and Environmental improvements), and this approach was adopted.
The communities, Pipalyatjara and Mimili, with populations slightly less than 300 each, are located in the Anangu Pitjantjatjara (AP) lands of Central Australia, in the northwest corner of the South Australia territory. At Pipalyatjara, a full SAFE-type intervention was undertaken, with the ‘E’ component designed and implemented by the NHC (Nganampa Health Council Inc.). At Mimili, only a SAF-type of intervention was implemented.
Baseline data was gathered for 18 months from March 1999 through September 2000 (five visits to Pipalyatjara and four at Mimili), and included determining trachoma prevalence levels using the WHO system, facial cleanliness, and nasal discharge parameters. A trachoma health program was implemented at the end of this period and a one-time dose of azithromycin was given in September of 2000. The chief focus of the study was children under 15 years of age.
Improvements in road sealing, landscaping, and the creation of mounds were started to improve dust control. Concurrently, efforts were made in the houses of the residents to improve the nine healthy living practices, which were scored in two surveys, in March 1999 and August 2001. Trachoma prevalence, and levels of facial cleanliness and nasal discharge were determined at 3, 6, and 12 months following antibiotic administration.
In children less than 15 years of age, the pre-intervention prevalence level of TF (Trachoma Follicular) was 42% at Pipalyatjara, and 44% at Mimili. For the 1-9 year age group, the TF prevalence was 47% and 54% respectively. For TI (Trachoma Intense), the pre-intervention prevalence was 8% for Pipalyatjara, and 9% for Mimili. The TF prevalence, adjusted for clustering, and using only individuals present at baseline and follow-up (3, 6, and 12 months post-intervention), was 41.5%, 21.2%, 20.0%, and 20.0% at Pipalyatjara respectively. For Mimili, the corresponding prevalence figures were 43.5%, 18.2%, 18.2%, and 30%.
In the 1-9 year age group, a lower TF prevalence existed between the pre-intervention and 12-month post-intervention points at Pipalyatjara compared to Mimili. The TF prevalence after the intervention was also lower for males compared to females, when the cohorts were grouped by gender, rather than community. It is posited that reinfection was much higher at Mimili within this age group, however, in both communities, there appeared to be a core of females whose trachoma status did not change. This is speculated as mainly being caused by prolonged inflammation, though persistent infection C. Trachomatis cannot be ruled out.
Facial cleanliness and nasal discharge continued to improve throughout the intervention at both communities, but at the 3-month post-intervention point no longer became a good predictor of trachoma.
It is not known whether the improvements in the environment at Pipalyatjara were responsible for the reduction in trachoma prevalence 12 months after the intervention, relative to Mimili.

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Clarke, Susan Elizabeth. "Gatekeeping and General Practice in the Australian Health System." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/24623.

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General practice is central to primary care in the Australian health system, yet difficulties proving the value of general practice are ongoing. Advocates of general practice often refer to a key role general practitioners (GPs) play in health system gatekeeping to emphasise the importance of general practice within the system. However, the concept of gatekeeping lacks clarity, and this may lead to unintended consequences for general practice. This thesis explores the concept of gatekeeping within the Australian health system by considering the expectations of general practice held by policymakers, advocacy groups and general practitioners concerning general practice as the controller of economic value in health care. The study analysed media releases from policymakers and advocacy groups and conducted interviews with 19 GPs. Using a methodology which attempts to reflect a general practice approach to problem solving, the study considered the discourse of policymakers, GPs and advocacy groups concerning waste within the system, to determine attitudes towards gatekeeping. The study found that policymakers, influenced by neoliberal ideas, equate good health with good economics and have an expectation that GPs will consider cost when making clinical decisions. GPs, while thoughtful of cost, prioritise patient well-being in treatment. Policymaker and GP expectations of care are opposed. While gatekeeping has appeal in a neoliberal environment, failure to meet economic expectations exposes GPs to accusations of poor practice. Advocacy for general practice should recognise the value of general practice in the Australian health system extends beyond reductionist financial expectations and re-centring policy discourse on health outcomes rather than economic outcomes is likely to have most success in improving the status of general practice within the system.

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McLaine, Catherine Clare. "Diabetes and oral health complications: Australian diabetes health care professionals' knowledge and scope of practice." Thesis, Curtin University, 2013. http://hdl.handle.net/20.500.11937/2373.

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The research investigated Australian diabetes health professionals’ (DHPs’) knowledge and their intervention, health promotion, and care management of oral health issues which impact upon the person with diabetes. Results identified the need for enhanced provision of diabetes-specific oral health education, clinical resource tools, and the delivery of oral health services. The findings were discussed within the context of the current health system policies and their impact upon DHPs’ management of diabetes related oral health complications.

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Boyce, Rosalie A. "The organisation of allied health professionals in Australian general hospitals." Thesis, Queensland University of Technology, 1996. https://eprints.qut.edu.au/107083/1/T%28BS%29%20134%20The%20organisation%20of%20allied%20health%20professionals%20in%20Australian%20general%20hospitals.pdf.

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This research is a case study in the sociology of professions. It reports on the Australian allied health professions, a group that has rarely been the subject of sustained research. The central purpose of the research is to examine the impact of local workplace organisation in Australian general hospitals in the public sector on the position of the allied health professions and their autonomy. Further, the research seeks to unbundle the competing claims about the utility of alternative organisational approaches and to examine how the allied health professions negotiate inter-professional relationships as a consequence of particular organisational approaches. The research draws on Eliot Freidson's professional dominance theory (medical dominance theory) as the underpinning theoretical framework. Medical dominance theory portrays the allied health professions as inevitably subject to medical dominance and subordination, a proposition which is critically appraised through a contemporary analysis of local workplace arrangements. To address these issues three models of allied health profession organisation were identified; the classical medical model, division of allied health model and the unit dispersement model. The research method involved a comparative case study approach and included fifty-three interviews, document analysis, observation strategies and key informants over a two year period. Data collection was guided by seventeen themes of inquiry which were identified from a multiple methods approach as likely to be important in a comparative analysis of the organisation of the allied health professions.

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Fleming, Brian James. "The social gradient in health : trends in C20th ideas, Australian Health Policy 1970-1998, and a health equity policy evaluation of Australian aged care planning /." Title page, abstract and table of contents only, 2003. http://web4.library.adelaide.edu.au/theses/09PH/09phf5971.pdf.

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Fares, Julian. "Modelling Stakeholder Integration Using Social Networks: An Australian Integrated Health Care Project." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20455.

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Stakeholders form relationships in projects to achieve both personal and project objectives. Proper stakeholder identification, categorisation and engagement methods that capture the social processes of the stakeholder network environment are lacking in many project management standards. In this study, social network theories and analytics are introduced as a new lens for stakeholder analysis to examine an integrated network of health care stakeholders (health care services and providers) that provides care for patients. The aim is to identify influential key stakeholders and determine the optimal network structure and composition for stakeholder integration (integrated care). A quantitative, whole network study was conducted where 56 health care providers were asked to report on their network relationships and the extent to which services are integrated in a geographic region in NSW, Australia. The results show that social network structure, position and relation constructs have a vital role in integrating health care stakeholders. More precisely, it was shown that ego-density, degree and betweenness centrality, tie strength and functional diversity have a positive association with service integration. In contrast, network efficiency, constraint and reciprocated relationships were found to be negatively associated with service integration. The research implications for the project management community are that stakeholders can be analysed and managed according to their relational attributes. With respect to integrated care, all stakeholders involved in integrated care projects should consider relationships configurations in their integration endeavour. Social network analysis is shown to be a vital tool for evaluating service integration where it identifies which services are currently working together; which ones are not working with others; where are the gaps in the relationships that can be strengthened and addressed.

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Przezdziecka, Krystyna. "Profile of Australian dentistry." Thesis, The University of Sydney, 1995. http://hdl.handle.net/2123/4687.

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Rogers, Gary. "Feeling queer can a primary health care approach mitigate health inequity experienced by homosexually active South Australian men? /." Connect to this title online, 2005. http://thesis.library.adelaide.edu.au/public/adt-SUA20060726.161708/.

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Ryan, John Joseph. "Strategy transformation and change : changing paradigms in Australian Catholic health and aged care." Thesis, Curtin University, 2001. http://hdl.handle.net/20.500.11937/1296.

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When I was younger I always conceived of a room where all these (strategic) concepts were worked out for the whole, company. Later I didn't find any such room .... The strategy (of the company) may not even exist in the mind of one man. I certainly don't know where it is written down. It is simply transmitted in the series of decisions made (Quinn 1978: 7). How do organisations in the Australian Catholic Health and Aged Care sector transform shared strategic thinking into formulated strategy? This research has investigated strategy formation, which can be defined as the process whereby the insights and thoughts of the key players in Catholic health and aged care are converted into formulated strategies. Specifically, the research analysed a major strategic amalgamation of the health and aged care operations of the Catholic Church in Australia, identified as Integration 2000. The concept of social constructs of meaning for the key actors is the fundamental perspective of this research. This required a constructivist ontology. The epistemology is interpretivist, and set out to provide a description of perceptions of the key actors as they engage in the formation of strategy. Defenders of interpretivism argued that the human sciences aim to understand human action (Schwandt, 2000:191). A qualitative methodology has been used to provide a plausible interpretation of the conversion process commonly referred to as strategy formation.A purposive sample was obtained. The data collection methods included qualitative interviews, attendance as an observer at two of the three day National Conferences of Catholic Health Australia and document analysis (see Chapter Three).A key focus of the research was the identification of planning models used to set the strategic context of organisations in Catholic health. The research showed that the prescriptive design and planning models were not used to plan broad strategy, but to implement strategies already formed by an emergent/learning process which, in Mintzberg et al's (1998) terms, would fit the learning, cultural and environmental schools of thought. Pinpointing a strategy school may not be a particularly fruitful exercise in this particular arena. It assumes that the distinctive act of deciding the future shape and the strategic management context of organisations charged with fulfilling a sacred mission can be classified into one school or another. The research also explored the perceptions of the Integration 2000 process, including the compatibility between the espoused philosophies and values of Catholic health and aged care and the behaviours evidenced during the Integration 2000 process. A diagnostic model was used to perform this evaluation. Rather than uncovering major discrepancies, this revealed some differences and some potential challenges.The espoused philosophies and values of Catholic health and aged care are those of compassion, collaboration, sense of community and, of course, financial viability. Pre-Integration 2000, particularly in health care, theories of organising and practices reflected values of independence and competitiveness, both between and even within religious orders. The findings from post-Integration 2000 suggested that theories of organising and practices were becoming more aligned with the original and continuing values, at the same time as responsibility for sustaining these values was being handed over from religious to lay trusteeship. There are still some outstanding issues before the Integration 2000 process achieves its objectives. The progress to date in bringing together so many components of such a disparate sector attests to the strength of the underlying value systems of Catholic health and aged care.

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Ryan, John Joseph. "Strategy transformation and change : changing paradigms in Australian Catholic health and aged care." Curtin University of Technology, Graduate School of Business, 2001. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=12141.

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When I was younger I always conceived of a room where all these (strategic) concepts were worked out for the whole, company. Later I didn't find any such room .... The strategy (of the company) may not even exist in the mind of one man. I certainly don't know where it is written down. It is simply transmitted in the series of decisions made (Quinn 1978: 7). How do organisations in the Australian Catholic Health and Aged Care sector transform shared strategic thinking into formulated strategy? This research has investigated strategy formation, which can be defined as the process whereby the insights and thoughts of the key players in Catholic health and aged care are converted into formulated strategies. Specifically, the research analysed a major strategic amalgamation of the health and aged care operations of the Catholic Church in Australia, identified as Integration 2000. The concept of social constructs of meaning for the key actors is the fundamental perspective of this research. This required a constructivist ontology. The epistemology is interpretivist, and set out to provide a description of perceptions of the key actors as they engage in the formation of strategy. Defenders of interpretivism argued that the human sciences aim to understand human action (Schwandt, 2000:191). A qualitative methodology has been used to provide a plausible interpretation of the conversion process commonly referred to as strategy formation.
A purposive sample was obtained. The data collection methods included qualitative interviews, attendance as an observer at two of the three day National Conferences of Catholic Health Australia and document analysis (see Chapter Three).A key focus of the research was the identification of planning models used to set the strategic context of organisations in Catholic health. The research showed that the prescriptive design and planning models were not used to plan broad strategy, but to implement strategies already formed by an emergent/learning process which, in Mintzberg et al's (1998) terms, would fit the learning, cultural and environmental schools of thought. Pinpointing a strategy school may not be a particularly fruitful exercise in this particular arena. It assumes that the distinctive act of deciding the future shape and the strategic management context of organisations charged with fulfilling a sacred mission can be classified into one school or another. The research also explored the perceptions of the Integration 2000 process, including the compatibility between the espoused philosophies and values of Catholic health and aged care and the behaviours evidenced during the Integration 2000 process. A diagnostic model was used to perform this evaluation. Rather than uncovering major discrepancies, this revealed some differences and some potential challenges.
The espoused philosophies and values of Catholic health and aged care are those of compassion, collaboration, sense of community and, of course, financial viability. Pre-Integration 2000, particularly in health care, theories of organising and practices reflected values of independence and competitiveness, both between and even within religious orders. The findings from post-Integration 2000 suggested that theories of organising and practices were becoming more aligned with the original and continuing values, at the same time as responsibility for sustaining these values was being handed over from religious to lay trusteeship. There are still some outstanding issues before the Integration 2000 process achieves its objectives. The progress to date in bringing together so many components of such a disparate sector attests to the strength of the underlying value systems of Catholic health and aged care.

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Ferguson, Lorraine J. "Health care reform and structural interests: Casemix as a tool for reform in the Australian health industry." Thesis, Queensland University of Technology, 2000. https://eprints.qut.edu.au/36766/1/36766_Digitised%20Thesis.pdf.

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This thesis uses a policy research framework to examine the development, implementation and evaluation of the casemix-based health care reform policies that were embedded within the 1988 and 1993 Medicare Agreements between the Commonwealth Department of Health and states and territories of Australia. Alford's (1975) conceptual framework of structural interests is used to examine the power of strategically placed interests in health care, and the barriers and challenges those interests pose to reform of the hospital system in particular. Alford (1975:14) argued that health systems must be understood in terms of the continuing struggle between the dominant structural interests (mainly doctors) and the challenging structural interests (government bureaucrats, health administrators, health planners and academic researchers) who try to reform the health system. Casemix-based hospital management information and funding systems provide tools for understanding hospital activity and costs and in doing so, provide incentives for improving efficiency and reforming clinical practice. The aims of the study were to gain a better understanding of the processes used in developing the reform policies; to explain in an analytical way, who influenced what was decided in relation to policy development and implementation; to examine the impact of the implementation of casemix-based funding policies in two Australian states from the points of view of the structural interests in health care; and to summarise the implications for future health care reform policy development m Australia. The data collection methods used for this study include depth interviews with fifteen casemix 'elites', a focused synthesis of important documents related to casemix policy, and secondary analysis of hospital activity data to evaluate the impact of casemix-based funding in the States of Victoria and South Australia. The findings clearly demonstrate that the inclusion of the casemix-based reform policies into the 1988 Medicare Agreements was a deliberate approach by the challenging structural interests to signal a new era of reform and accountability for the Australian public hospital system. The use of the Casemix Development Program as a policy instrument was seen by the stakeholders to have a positive impact in terms getting commitment to policy direction and for developing expertise in casemix-based systems, but it was criticised for a lack of research priorities and the subsequent waste of funds. Casemix-based funding systems were seen by the stakeholders to have both positive and negative aspects. Both the challenging and dominant structural interests agreed that there was an improvement in management information and financial systems, giving them better information for budget allocation and resource management. This resulted in improved hospital access and efficiency, as measured by patient throughput, length of stay and average cost per casemix-adjusted separation. The dominant structural interests found that with better information and more accountability for resource use there was an improved focus on team work and patient management. Despite these improvements, there was a belief among the dominant structural interests that quality of care had deteriorated under casemix-based funding. Negative aspects of casemix-based funding systems were seen to include a focus on technical efficiency at the expense of allocative efficiency and an emphasis on acute hospital services and throughput without consideration of the resources required for other services; particularly community services which had to deal with early discharges. Stakeholders also felt that there was increased pressure on bedside clinical staff with the increases in patient throughput and acuity, and that these pressures threatened the ability of so called teaching hospitals to adequately train health professionals and to conduct research. While the casemix-based reform policies resulted in a coalition of the challenging and dominant structural interests to improve health care delivery in Australia, there is no evidence to suggest that there has been any real change in the social, economic and political structures which reinforce medical dominance in health care in Australia. Recommendations for future policy research and policy learning are made with a view to improving the nature of health care reform policy and its impact on the health of the Australian population.

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Rushton, Carole. "Performing Health Partnerships: A Critique." Thesis, Griffith University, 2013. http://hdl.handle.net/10072/367579.

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Health partnerships have become commonplace in Australia following the introduction of mandatory partnering by Australian state and federal governments since the late 1980s. However, very little is known about how they actually perform as partnerships. This study describes the emergence of an Australian community-based health promoting partnership known as the Logan-Beaudesert Health Coalition (LBHC). The LBHC was a response by Queensland’s state government in 2005 to the increased incidence and prevalence of chronic disease in the peri-urban regions of Logan and Beaudesert, which are characterised by their cultural diversity and socio-economic disadvantage. This qualitative study contributes to health partnership research empirically, methodologically and theoretically. Alternative epistemologies and a new methodological approach are introduced under the rubric of critical social science. These were used to generate new descriptions and diagnoses of how the LBHC was being performed as a partnership. A literature review was conducted to examine what was already known about health partnerships. Studies of health partnerships were reported as being too data driven, undertheorised and more generally, as lacking empirical evidence and critical appraisal of health partnerships. Most studies asked, “Are health partnerships successful?” relatively few asked, “How are they performed as partnerships?” A review of the health partnership also revealed limited exploration of alternative methodologies and methods such as governmentality and ANT, which have the potential to enhance understanding of how health partnerships are performed as partnerships.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Human Services and Social Work
Griffith Health
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19

Henderson, Joan Veronica. "The effect of computerisation on the quality of care in Australian general practice." University of Sydney, 2008. http://hdl.handle.net/2123/2649.

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Doctor of Philosophy (PhD)
This thesis describes a study of the utilisation of computers by individual general practitioners (GPs) in Australia, and compares the practice behaviour of GPs who use a computer as a clinical tool, either by prescribing, ordering tests, or storing patient data in an electronic medical record format, with those who do not use a computer for these functions. A survey of individual GP’s use of computers was conducted among 1,336 GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) program between October 2003 and March 2005. The GPs were then assigned to groups according to their clinical use (or not) of a computer, and were compared on a range of variables including the characteristics of the GPs themselves, their practices, their patients, the morbidity they managed for their patients, and the managements they provided. Their behaviour was also compared, using a set of quality indicators designed for use with the BEACH data, and applicable in a primary care setting, to determine whether the clinical use of a computer has an affect on the quality of care GPs provide to their patients. Finally, GPs who use clinical software with embedded pharmaceutical advertising were compared with GPs not exposed to advertisements via this media, to determine whether such advertising influences the prescribing behaviour of GPs to favour advertised brands. From 44 quality indicators examined, clinical computer users performed ‘better’ on four and ‘worse’ on four. For the remaining 36 they exhibited no difference. Exposure to pharmaceutical advertising embedded in clinical software did not influence the prescribing behaviour of the GPs so exposed. Despite the belief espoused in the literature that computer use will improve the quality of patient care, I have found no evidence to demonstrate that the use of a computer for clinical activity has (as yet) affected, either positively or negatively, the quality of care GPs provide to their patients. The current push to computerise general practice will mean that this method of assessment will be difficult to replicate in the future, given the absence of control groups. Other research methods will need to be developed.

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Henderson, Joan. "The effect of computerisation on the quality of care in Australian general practice." Thesis, The University of Sydney, 2007. http://hdl.handle.net/2123/2649.

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This thesis describes a study of the utilisation of computers by individual general practitioners (GPs) in Australia, and compares the practice behaviour of GPs who use a computer as a clinical tool, either by prescribing, ordering tests, or storing patient data in an electronic medical record format, with those who do not use a computer for these functions. A survey of individual GP’s use of computers was conducted among 1,336 GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) program between October 2003 and March 2005. The GPs were then assigned to groups according to their clinical use (or not) of a computer, and were compared on a range of variables including the characteristics of the GPs themselves, their practices, their patients, the morbidity they managed for their patients, and the managements they provided. Their behaviour was also compared, using a set of quality indicators designed for use with the BEACH data, and applicable in a primary care setting, to determine whether the clinical use of a computer has an affect on the quality of care GPs provide to their patients. Finally, GPs who use clinical software with embedded pharmaceutical advertising were compared with GPs not exposed to advertisements via this media, to determine whether such advertising influences the prescribing behaviour of GPs to favour advertised brands. From 44 quality indicators examined, clinical computer users performed ‘better’ on four and ‘worse’ on four. For the remaining 36 they exhibited no difference. Exposure to pharmaceutical advertising embedded in clinical software did not influence the prescribing behaviour of the GPs so exposed. Despite the belief espoused in the literature that computer use will improve the quality of patient care, I have found no evidence to demonstrate that the use of a computer for clinical activity has (as yet) affected, either positively or negatively, the quality of care GPs provide to their patients. The current push to computerise general practice will mean that this method of assessment will be difficult to replicate in the future, given the absence of control groups. Other research methods will need to be developed.

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21

McGregor, Rodney. "Introduction of a Sonographer Practitioner Role in the Australian Health Care System: Opportunities and Barriers." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/10136.

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In Australia, the majority of sonographers produce an informal report describing the ultrasound findings and a medical practitioner then translates this informal report into the final ultrasound report. This thesis will review the professional role of Australian sonographers and examine sonographer views on formally extending their role to include full responsibility for both the ultrasound examination and completion of the final written report. In sonography, this role extension has been given the title of sonographer practitioner. The research employed a mixed-method research design incorporating quantitative and qualitative methods. A survey of members of the Australian Sonographers Association consisted of closed-ended questions that provided demographic data, type and location of workplace and views concerning sonographer practitioner development. Complementing the closed-ended questions, three opened-ended questions sought information about what would encourage or discourage sonographers from being involved in some form of role extension and the opportunity to comment on sonographer practitioner issues. The themes and concepts identified in the qualitative component of the survey were then explored, in greater depth, with a small sample of survey respondents who agreed to participate in a follow-up individual semi-structured interview. Results from the survey revealed that a majority of respondents (82%) thought there is a need to extend sonographer career pathways. Respondents indicated they were in favour of sonographer practitioner development, and a majority (66%) also indicated they would consider becoming a sonographer practitioner. Analysis of the opened-ended survey questions found the most commonly described incentives or motivations for sonographer practitioner development were professional recognition, remuneration and increased knowledge. Conversely, the most commonly perceived barriers were legal issues, insurance and further study. The survey and subsequent interviews revealed a range of opinions and views as to what duties would constitute a sonographer practitioner role, ranging from reporting on ultrasound studies to undertaking interventional studies. The interviews revealed that some sonographers were already performing in extended roles, including reporting on ultrasound examinations, in a variety of working environments, although this role is not formally recognised within the Australian health care system. Formal recognition of a sonographer practitioner role would offer an extended career pathway to sonographers and work to minimise litigation risks of sonographers working in extended roles now and in the future.

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22

Van, Loggerenberg Valerie. "Australian volunteers in the health sector : antecedents to volunteers' intention to leave /." Murdoch University Digital Theses Program, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20090409.113755.

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23

Bakker, Susette. "Covert violence in nursing: A Western Australian experience." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2012. https://ro.ecu.edu.au/theses/455.

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Covert violence in the workplace has been extensively theorized amongst social scientists as having negative effects on the worker’s self esteem, job satisfaction and stress, resulting in increased absenteeism and a reduction in productivity, and yet it continues to fester in nursing. The purpose of this research was twofold. The first was to answer the question, ‘What are the characteristics of covert violence experienced by Western Australian nurses?’ and through the description of Western Australian nurses’ experience of covert violence and describe the characteristics related to this to form a definition of covert violence. The second question was ‘What are the causes of covert violence experienced by Western Australian nurses? This study explored nurses’ experiences of covert violence using an interpretive phenomenological approach as described by van Manen (1997). A literature review was conducted to establish the findings of studies in relation to covert violence in other countries and to compare similar works in Australia. Using literature review findings, interview questions were designed to identify episodes of covert violence amongst nurses, the background to the reported events and a comment by the participants as to how these episodes were dealt with. A proposed model of the causes of covert violence in nursing was developed from the literature review to be tested in relation to the research findings. Research participants were all Registered Nurses with the Nurses’ Board of Western Australia who were asked to identify and discuss their experiences of covert violence in their workplaces. The data collected was analysed using pattern matching for qualitative evaluation. Results obtained from the data analysis identified the most important factor leading to covert violence was the juxtaposition of power and powerlessness and how it was influenced by community expectations of healthcare, staffing and client characteristics, infra-staff issues and management systems. Based on the research findings a revised model of causes of covert violence was developed to identify how power and powerlessness affect the outcomes of patient care, staff morale and the ultimate retention of staff in the health service in particular and in the profession generally. To record the incidences of covert violence and how they can be dealt with, a risk action plan and a model of obligations to prevent covert violence in nursing was developed that would not only serve its purpose in the nursing profession. From these questions it was possible to develop a Risk Control Action Plan that can be applied in response to reports of covert violence and to prevent covert violence in the nursing workplace, and can be adapted to address a similar situation in any other workplace. The tools developed include ways of reducing patient stress, methods of improving staff relationships, and management tools for issues that need to be addressed by nurses and administrators. Recommendations for further research to extend this study and to test the covert violence prevention tools developed as a result of this research are made. It is anticipated that use of the revised model of covert violence in nursing, definition of covert violence and tools developed as a result of the research findings will minimise incidences of covert violence, resulting in greater job safety and satisfaction for nurses, a reduction in staff absenteeism due to job stress, and an improvement in nursing retention and productivity.

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Menzies, Allan R., and n/a. "Attitudes to euthanasia amongst health care professionals in the Australian Capital Territory : issues towards a policy." University of Canberra. Administrative Studies, 1991. http://erl.canberra.edu.au./public/adt-AUC20061017.152535.

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Three groups of health care professionals were canvassed for their views on euthanasia - student nurses, practising nurses and doctors. The aim of the research was to make a possible contribution to a formalised health policy on this issue for the ACT. The following forms of euthanasia were covered by the research: (i) voluntary active euthanasia: (ii) voluntary passive euthanasia: (iii) involuntary active euthanasia: (iv) involuntary passive euthanasia. Passive forms of euthanasia were found to be the most acceptable. Voluntary forms of euthanasia were not found, in general, to be more approved of than involuntary forms of euthanasia. However, active forms of euthanasia were much less acceptable than passive forms. In order to adapt the research findings to a methodology for policy use. Allison's models (1971) of public policy development were modified into a single model. This provided an application of the research results in such a way as to allow for the development of a possible formalised policy on euthanasia, and practical applications. The conclusions drawn from the research findings and the subsequent recommendations are supportive of law reform and the implementation of a new policy on the issue of euthanasia.

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25

Yeoman, Sara. "Do neo-liberal ideologies disadvantage those with mental illness within the Australian mental health care system?" Thesis, Department of Sociology and Social Policy, 2009. http://hdl.handle.net/2123/7143.

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Within current academic literature pertaining to the social policy of mental health, there is a general acknowledgement that the mental health system utilised in Australia is inadequate. The history of the mental health system is tumultuous and yet recent times have shown a marked move towards the incorporation of systems aimed at aiding those who suffer from mental disorders. Given the constantly changing nature of how mental illness itself and its treatment are perceived it has been studied, and is continually studied under a variety of paradigms. Currently, in conceptualising and analysing the mental health system, it is considered within academic discourse through Social Policy. In the past, social policy has been analysed using several different theoretical frameworks including Marxism and social democratism. However, this thesis argues that neither are adequate in explaining the current issues within the mental health system, and argues that the current system is better conceptualised within a neoliberal framework. Furthermore, it is considered that the employment of this ideology has had detrimental effects on the current mental health system employed within New South Wales. As such, this thesis argues that the employment of neoliberal ideologies has resulted in disadvantaging those with mental illness. This conclusion was reached through three different methodological approaches. The first two were aimed at ascertaining different attitudes and involved interviews with social workers within the system and a content analysis of the media. The final approach served two purposes, to analyse the usability of the Australian Government’s website and to ascertain the facilities available to those with mental illness. Despite methodological flaws it was surmised that the employment of neoliberal ideologies within the mental health system of Australia significantly disadvantages those with mental illness.

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Puspitasari, Hanni Prihhastuti. "Secondary Prevention of Cardiovascular Disease in Primary Health Care: the Role of Australian and Indonesian Pharmacists." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/14335.

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This PhD project was designed to explore the scope of Australian and Indonesian community pharmacists’ activities and the determinants of their scope of practice in supporting CVD secondary prevention. In-depth, semi-structured interviews were conducted with community pharmacists in New South Wales (NSW) Australia (n=21 ) and in East Java Province, Indonesia (n=20). The findings of the Australian interviews were used to develop a survey instrument that was pilot-tested with 85 NSW community pharmacists. The revised survey instrument was mailed out to a random sample of 1,350 Australian community pharmacies. The scope of Australian community pharmacist practice in CVD support ranged from medicine information provision only to comprehensive support. The determinants of their practice comprised: “people”, “environment” and “outcome” factors. CVD support is likely to be provided if community pharmacists strongly believe that this is part of their scope and if their pharmacies have adequate infrastructure and employ sufficient numbers of pharmacists with appropriate and relevant knowledge and skills. The majority of Indonesian participants did not consider that they have a role in CVD support. There is a need for coordination across health, education and governance sectors to enhance pharmacists’ practice in chronic disease management in the primary health care setting.

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27

Jamieson, Rachel. "Parent-mediated pathways to care for rural adolescents with depression." Thesis, University of Ballarat, 2008. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/54314.

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28

Angell, Blake Joseph. "Health Economics and Indigenous Health: measuring value beyond health outcomes." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17287.

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Australia has decades of public policy experience attempting to overcome the disparities in health outcomes facing Aboriginal and Torres Strait Islander (Indigenous) Australians. Significant resources have accompanied these policy initiatives, however, Indigenous Australians continue to bear a heavier burden of death, disease, disability and economic hardship than other Australians. Despite the policy experience of Australia and widespread support for initiatives to overcome Indigenous disadvantage, there is little consensus on the best means to actually do so. Working to ensure that available resources are used in their most effective way possible is vital to improving the health of Australia’s Indigenous populations. At its broadest level, health economics is the study of the choices made in the allocation of scarce resources to improve the health status of populations and service delivery. Notwithstanding the political, moral and economic importance of the issue, there remains limited health economic research in the field of Indigenous health nor is there a developed evidence base to provide guidance to policy-makers looking to invest in cost-effective interventions. Further, health economic methods have been criticised as potentially inappropriate for the area of Indigenous health. Current methods for economic evaluation tend to adopt a reductionist approach based on a cost per health outcome paradigm and are potentially insensitive to the outcomes and processes that Indigenous people see to be of value to their health and health care on three broad and related levels. First, Indigenous conceptions of health have been shown to differ from the biomedical notions which tend to underlie the reductionist approach of health economic evaluations. Second, a central tenet of Indigenous health care is community ownership and control of healthcare services. As such there is value associated with how well services achieve engagement with communities which may also be missed through a reductionist health economic approach. Third, social determinants of health have also been demonstrated to be particularly important to the health outcomes of Indigenous Australians but again have tended to lie outside the domain of traditional economic evaluation methods. Potentially because of these and other difficulties, resource allocation decisions in the field of Indigenous health have been made without a strong economic evidence-base and have instead seemingly relied on rights-based arguments promoting investment based on the sizeable need that these communities face. While there is no denying the stark disadvantage facing Australia’s Indigenous populations, such rights-based arguments provide little guidance on how much to invest or on trade-offs between different policy options or individual service components. Further, the weight attributed to such arguments has tended to vary according to the prevailing political climate. Health economic approaches on the other hand, can provide evidence based on value that can transcend politics and lay the foundation for rational priority-setting that maximises the health of target populations. Ignoring the realities of resource scarcity in the sector will not allow policy interventions to maximise the health outcomes for Australia’s Indigenous communities. Health economic methods such as discrete choice experiments (DCEs) and contingent valuation studies have been used to value factors outside of traditional economic evaluations in other fields yet have been largely untested in Australian Indigenous populations. Such techniques potentially represent a direct means through which to incorporate Indigenous values and preferences into the evaluation and design of health programs and ultimately a mechanism for the sector to demonstrate the value and impact that properly designed services can have. There is limited empirical understanding of the role of culturally-specific healthcare providers in terms of the service use patterns of these communities and overcoming the barriers that face Indigenous Australians attempting to access health services. Examining these issues through an economic lens is likely to provide a level of guidance to policy-makers that is currently absent from Indigenous health policy in Australia. This thesis explores these issues through a mixed-methods approach investigating the application and merits of a variety of health economic methods in these populations. Chapter 1 introduces the major issues in the field and provides an overview of the published literature carried out to date. Chapter 2 presents a more detailed investigation of the economic evaluation literature with a systematic review of published economic evaluations investigating health interventions in Indigenous populations around the world. The review finds relatively limited economic evaluation of health care interventions for Indigenous populations in Australia or globally, however, what has been done has demonstrated the potential for cost-effective interventions in these populations. Almost no consideration of alternative conceptions of health or Indigenous-specific values were found through the review. Chapter 3 examines this issue further, investigating the use of health-related quality of life (HRQoL) instruments in these populations, one of the most direct method to incorporate Indigenous conceptions of health into evaluations of health programs, through a systematic review of the use of these instruments in Indigenous populations around the world. The review found that while HRQoL instruments have been used to elicit the quality of life of Indigenous populations their use was relatively limited, as was evidence of the validation of these instruments in these population groups. The evidence that does exist suggests that some Indigenous populations potentially conceptualise these issues fundamentally differently to populations in which these tools have been designed and validated. Chapter 4 discusses the findings of the reviews presented in Chapters 2 and 3 in light of the Australian policy context. The chapter argues that the policy environment has emphasised rights-based rather than economic arguments in resource allocation decisions that has left room for efficiency and equity improvements in the way that resource allocation decisions are made in the field of Indigenous health. Given this, the chapter calls for further work to investigate the service utilisation of Indigenous populations and the role of culturally-specific healthcare providers and incorporate Indigenous values to value programs to improve Indigenous health including through contingent valuation and discrete choice experiment methodologies. Chapter 5 takes up the first of these issues with an analysis of the healthcare expenditure of a cohort of Indigenous and non-Indigenous Australians at high-risk of cardiovascular disease to investigate the relative service utilisation of the two groups. The analysis finds that when individuals are engaged with care providers, culturally-specific providers were providing equivalent care to mainstream providers in non-remote areas and factors other than patient Aboriginality seem to be more important in determining the healthcare expenditure of these high-risk patients. The chapter also highlights problems with current data collections in the field that acts to obscure analysis of service utilisation patterns of Indigenous Australians, particularly in remote areas, and comparisons between the relative service use of Indigenous and non-Indigenous Australians. Chapter 6 further investigates the role of culturally-specific service providers through a DCE attempting to value the cultural component of a fall-prevention service. The chapter presents the findings of a DCE carried out in a cohort of older Aboriginal people receiving a culturally-specific fall-prevention intervention. The chapter demonstrates that DCEs provide a potential means to incorporate the preferences of Indigenous communities into the design and evaluation of health services. A value for the cultural component of the service was derived through the DCE and the relative importance of different barriers to care to the decision-making of the participants were investigated. Chapter 7 presents the findings of a contingent valuation study investigating the value that the Australian community places on holding a driver licence as an example of a social determinant that has been shown to be associated with positive health outcomes in Indigenous populations. The analysis finds contingent valuation techniques can provide a means to value social determinants of health that lie outside traditional health economic evaluations and to value broader policy interventions to improve living standards. Chapter 8 puts forward the main findings of this thesis arguing that the health economics field has an important role to play in improving the health of Australia’s Indigenous populations. Appropriate targeting of available resources is essential to close the gap in health outcomes between Indigenous and non-Indigenous Australians. Economic research is vital to build an evidence-base for policy makers looking to invest in cost-effective policy options and this needs to be based on factors that Indigenous communities consider important to their health and healthcare. Potential for economic evaluation of programs needs to be a key consideration in resource allocation decisions in the field. These need to be robust enough to incorporate the factors that are important to Indigenous Australians. The role of culturally-specific providers needs to be better understood as do the different components that make up such a service. Finally, incorporating social determinants of health into the health policy environment remains crucial in the field of Indigenous health. Given the political, moral and economic importance of overcoming the disparities faced by Australia’s Aboriginal and Torres Strait Islander communities, the relative lack of health economic research in the sector is a failing of the field in Australia. Building an economic evidence base will assist those working in the sector to demonstrate the value of appropriately designed, culturally acceptable healthcare services and decision-makers in the field to move beyond rights-based arguments for funding decisions. Collectively this will enable a system of rational priority-setting in the sector whereby the health impacts derived from scarce resources are maximised.

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van, Eyk Helen, and helen vaneyk@health sa gov au. "Power, Trust and Collaboration: A case study of unsuccessful organisational change in the South Australian health system." Flinders University. Medicine, 2005. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20060130.095828.

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Internationally, health systems have been undergoing an extended period of endemic change, where one effort at health system reform inevitably seems to lead to further attempts to make adjustments, re-direct the focus of the reform effort, or bring about further, sometimes very different changes. This phenomenon is described as churning in this thesis. Churning is a result of continual efforts to adjust and ï¿½improveï¿½ health systems to address intractable ï¿½wickedï¿½ problems, often through applying solutions based on neo-liberal reform agendas that have influenced public sector reform in developed countries since the early 1980s. Consistent with this, the South Australian health system has been caught up in a cycle of change and restructuring for almost thirty years. This qualitative study explores a case study of unsuccessful organisational change initiated by a group of health care agencies in the southern metropolitan area of Adelaide, South Australia, which took place between 1996 and 2001. The agencies sought to develop and establish a regional health service through a process they called ï¿½Designing Better Health Care in the Southï¿½ which aimed to improve the way that services were provided in the area, and to enable the agencies to manage the increasing budgetary and workload pressures that they were all experiencing. A significant policy shift at the state government level meant that this initiative was no longer supported by the central bureaucracy and could not proceed. The agencies reverted from a focus on regional planning and service delivery to an institutional focus. The changes that are described within the scope of the case study are universally recognisable, including centralisation, decentralisation, managerialism and integration. The experience of Designing Better Health Care in the South as an unsuccessful attempt to implement change that was overtaken by other changes is also a universal phenomenon within health systems. This study locates the case study within its historical and policy contexts. It then analyses the key themes that emerge from consideration of the case study in order to understand the reasons for constant change, and the structural and systemic impediments to successful reform within the South Australian health system as an example of health systems in developed countries. As a case study of organisational change, Designing Better Health Care in the South was a story of frustration and disappointment, rather than of successful change. The case study of Designing Better Health Care in the South demonstrates the tensions between the differing priorities of central bureaucracy and health care agencies, and the pendulum swing between the aims of centralisation and regionalisation. The study uses the theory of negotiated order to understand the roles of the key themes of trust, partnership and collaboration, and power and control within the health system, and to consider how these themes affect the potential for the successful implementation of health care reform. Through analysis of the case study, this thesis contributes to an understanding of the difficulties of achieving effective reform within health systems in advanced economies, such as the South Australian health system, because of the complex power and trust relations that contribute to the functioning of the health system as a negotiated order. The study is multidisciplinary and qualitative, incorporating a number of social science disciplines including sociology, political science, historical analysis and organisational theory. Data collection methods for the study included interviews, focus groups, document analysis and a survey.

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30

McCullough, Kylie. "The delivery of Primary Health Care in remote Australian communities: A Grounded Theory study of the perspective of nurses." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2018. https://ro.ecu.edu.au/theses/2153.

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Around 85% of Australia’s landmass is remote and sparsely populated. Across these vast areas of desert, wilderness and tropical islands, nurses provide the majority of health care services. The residents of Australia’s remote communities have poorer health status than their metropolitan counterparts. The proportion of Indigenous people is high and health and social disadvantage is widespread. The characteristics of each remote community are unique and often reflect challenges associated with distance to tertiary health services and limited health resources. As a result, nursing practice within this context is very different to other nursing contexts. Despite recognition of Primary Health Care (PHC) as a comprehensive model of acute and preventative care well suited to areas of high health and social need, there is little known about how nurses use the PHC model in practice and research pertaining to this nursing context is limited. This study was conducted from a Constructivist Grounded Theory perspective to generate a substantive theory. Data were collected through 23 telephone interviews and an expert reference group. This study adds previously unknown information to the body of work about remote area nursing. The context of providing PHC in a remote setting was described as social with a focus on illness prevention and equality of care. Participants described personal satisfaction as a feeling of making a difference to the health and wellbeing of the community. However, the core issue participants faced was the inability to provide PHC. Four conditions that impacted on the core issue, were described as: understanding of the social world of the remote community, availability of resources, clinical knowledge and skill and, shared understanding and support. The process labelled doing the best you can with what you have emerged as the way participants dealt with the inability to provide PHC. The process involved four primary activities: facilitating access to health care, continually learning, seeking understanding, and home‐making in a work environment. The outcome of this process was considered to be making compromises to provide PHC. This study proposes a substantive theory to understand and explain Australian remote nursing practice. Recommendations include further exploration, testing and refinement of the substantive theory. The implications for practice include development of education and support programs and the findings promote the case for providing additional resources to health services in remote areas in order to support nurses in providing PHC.

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31

Bennett, Paul J. "An investigation into the health related outcomes of surgery performed by Fellows of the Australian College of Podiatric Surgeons." Thesis, Queensland University of Technology, 1999. https://eprints.qut.edu.au/36746/1/36746_Digitised%20Thesis.pdf.

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Health care providers in the United States, United Kingdom and Australia debate the need for expanding the role of podiatrists' to include the surgical care of foot problems. Paradoxically, during a twelve month period from July 1995 to June 1996, Fellows of the Australian College of Podiatric Surgeons (FACPS) performed over 1,500 individual surgical operations on approximately 785 Australians. Few prospective investigations of podiatric surgeon outcomes have been conducted, none of which have taken place in Australia. More particularly, no studies have used valid psychometric instruments to measure the effects of care provided on patients' "health related quality of life". The research contained in this thesis deals with the conceptualisation, development and validation of a new health status instrument: the Foot Health Status Questionnaire. This instrument has been developed with the specific intent of investigating the impact of FACPS on patients' health related quality of life. One hundred and forty-two subjects treated by eleven Fellows for orthopaedic, neurological or integumentary systems diseases of the foot were recruited into a six month long quasi-experimental repeated measures (time series) study. The study identified that the vast majority of subjects (more than 92%) who underwent foot surgery experienced significant improvements' in a range of health related quality of life dimensions and indicated that they would undergo their procedure again. In particular, a MANCOVA analysis demonstrated that subjects' reported reduced levels of foot pain, increased levels of physical function, improved general foot health perception and footwear related quality of life, up to six months after their respective operations. Adverse effects of surgery identified in this study include a significant short-term functional disability for subjects' undergoing orthopaedic correction of foot problems and, in the immediate post operative phase, a significant reduction in social function for all three groups of subjects'. Generic measures of General Health and Vitality, as captured by the Short Form 36 health status instrument, were unaffected by Fellows treatment. This study did not identify any significant short to medium term morbid outcomes. Assessment of patients' satisfaction with surgery one, three and six months postoperatively reflected a general under-reporting of the beneficial effects of foot surgery. These findings support the premise that; specific health related quality of life measures provide significant explanatory power about the outcomes of care compared with the more traditional approach of evaluating patient satisfaction with surgery. In summary, it has been recommended that podiatrists, like other health care professionals, use recognised methods to determine whether their care meets professional standards and to generate evidence to prove that it does. This research contributes to meeting this important public health need.

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32

Coorey, Genevieve. "Evaluation of a Consumer-Focused eHealth Strategy for Cardiovascular Disease Risk Reduction in Australian Primary Care Attendees." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/22079.

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Cardiovascular disease (CVD) is the leading cause of non-communicable disease mortality worldwide and prevention is a critical national and international priority. Education, counselling and pharmacotherapies target modifiable determinants of atherosclerotic CVD. Helping patients adopt and adhere to prevention recommendations requires innovative strategies. Technology-based approaches offer an opportunity to increase consumer participation in disease prevention behaviours, and in their health care more generally. Alongside effectiveness outcomes, trials of complex health interventions require evaluation of core process questions about fidelity of implementation, which components work, and the role of contextual variables. This thesis presents a systematic mixed methods process evaluation of the design and implementation of a novel complex intervention for CVD risk factor reduction in the primary care setting. Chapter 1 describes the epidemiology and prevention of CVD, and the place of process evaluation in trials of eHealth innovations targeting chronic disease management. Thereafter, the thesis represents a ‘lifecycle’ approach to quality in eHealth evaluation research, from needs assessment and concept formation (Chapters 2 and 3); to implementation (Chapter 4); to exploratory and explanatory phases looking at variations in uptake (Chapter 5); and finally to stakeholder satisfaction and impact (Chapters 6 and 7). Overall, patients with CVD and general practitioners (GPs) were receptive to eHealth for disease self-management. Benefits have been reported for some important clinical measures and lifestyle behaviours. Influential sociocultural factors for eHealth engagement and non-usage attrition were elucidated from exploring the interaction of the intervention with contexts of use. Process evaluation enriched the evidence for how an innovative eHealth approach to CVD risk reduction was designed, implemented, used, and accepted by GPs and their patients.

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33

Ibell, Bernadette Mary, and res cand@acu edu au. "An Analysis of Mental Health Care in Australia From a Social Justice and Human Rights Perspective, With Special Reference to the Influences of England and the United States of America: 1800-2004." Australian Catholic University. School of Philosophy, 2004. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp113.25102006.

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The aim of this thesis is to analyze mental health care in Australia from a social justice and human rights perspective, in order to demonstrate that social justice as a philosophical manifestation of justice and fairness, is an essential ingredient in the theory and practice of mental health care. It is contended that the needs of the mentally ill would be most appropriately answered by the utilization of a Natural Law model, based on Finnis’s Natural Law theory. The Scope of the Thesis.The needs and care of the mentally ill are discussed, together with the treatment meted out to these vulnerable members of society since, approximately, the year 1800. Neither the criminally insane, nor the intellectually disabled are included in this discourse. Each group of people merits a thesis on its own: criminal insanity requires a debate to include the history, psychiatric and legal approaches to the subject, and current management of the insane. The intellectually disabled are not mentally ill; their ability to function as all round, naturally competent individuals is diminished by an inadequacy and/or impairment of their intellectual capacities. The needs of these two groups are far too broad and demanding to be included within the current thesis. Rationale for the Timeframe The timeframe, 1800 until 2004, has been established because it approximates to the transition from the end of the Classical through the Modern Age to the Post Modern Age, together with the predominance of Enlightenment philosophical theories, and the development of a scientific approach to medicine. Further, many politico-economic and social changes were taking place, associated with the Industrial Revolution. All are shown to have affected the introduction of asylumdom, and the institutionalization of those unable to participate actively in the industrial workforce. Of significant importance to the development of institutionalization for such marginal groups is the philosophy of Jeremy Bentham. Bentham espoused Classical Utilitarianism which will be shown to believe that the ultimate standard of utility is not the individual’s happiness but the greatest amount of happiness altogether. The thesis will demonstrate that this philosophical view prevailed from the beginning of the Industrial Revolution, with Benthamism influencing the sequestration of the unemployable into institutional life. Development of the Thesis.The thesis is developed against a background of prevailing philosophical, and other changes as stated above, including the medicalization of mental illness and the development of psychiatry as a branch of medicine. There is manifestation of many social injustices to those incarcerated in the asylum in all three countries under consideration: England, USA, and Australia. It is demonstrated that social justice and human rights of their work forces were disregarded by many employers at the time of the Industrial Revolution. Such values were, therefore, unlikely to prevail with regard to the mentally ill. Asylumdom continued with few changes in its practices until after World War II. It is shown that the predominance of post Enlightenment theories, together with further politico-economic, social and pharmaceutical revolutionary change followed the Second World War. Encouraged also by the founding of the United Nations and World Health Organizations as well as provision of the Declaration of Human Rights, circumstances led to the process of de-institutionalization of the mentally ill. The latter were decanted with apparently unseemly haste into a community ill prepared for such a change, and with little evidence of infra- structure to support the move. Need to conduct a National Inquiry. There was, then, a need to investigate what was now an overt issue of mental health care. The two subsequent inquiries by the Australian Health Ministers Advisory Council, (AHMAC) and the Burdekin Report, both focused on social justice issues, and addressed epidemiological, economic, sociological and justice considerations. Within the thesis, both investigations are critiqued against a Natural Law model, using Finnis’s Natural Law theory. It is demonstrated that contrary to Enlightenment principles of social justice as described by Miller, such a theory is eminently practical, and answers the needs of all members of the community, providing not merely ‘the greatest happiness for the greatest number’ but the common good of all Conclusion. Evidence shows that such a Natural Law theory is required to give a firm foundation to the needs of the mentally ill, especially at a time when relativism, economic rationalism and negative aspects of globalization prevail. Without such a basis the mentally ill are left insecure, uncertain and adrift in a world uncaring of their plight, while all the earnest exhortations espoused by Reports remain platitudes, subject to the whims of whatever government is in power. Our responsibilities to all our fellow human beings demand better from us than this.

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34

Williams, Anne-Marie M. "Trace elements in nineteenth-century Australian children's teeth in relation to diet, health and the environment." Thesis, The University of Sydney, 2005. https://hdl.handle.net/2123/27919.

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The principal aim of this thesis is to explore the relationship between trace elements in the tooth enamel of children from the Destitute Children’s Asylum (DCA), who died in the mid-to-late nineteenth century and their health, diet and environment, as determined from historical records and osteological stress markers. The secondary aim is to explore the validity of trace element analysis in archaeological populations in relation to paleodiet and health status. The major issue surrounding the use of trace element analysis in archaeological samples has been the impact of diagenesis, that is where the bone chemistry is altered post-mortem. Although it is generally considered that enamel is more stable than bone, the degree to which tooth enamel may be affected by the post-mortem environment is not clear. The possibility that the enamel of the teeth from the DCA was affected by diagenesis was examined using a number of techniques including microprobe analysis. The DCA was set up in 1852 to care for children whose parents were unable or ‘unfit’ to care for them. In 1995, the cemetery, which operated from 1863 until 1891, was excavated and 65 burials were found and it is the analysis of these remains that forms the basis of this thesis. The techniques used for trace element analysis in this thesis were Proton Induced X-ray Emission (PIXE) and Gamma-ray Emission (PIGE) analysis. PIXE/PIGE allows for multi—element analysis and can be performed without destruction of the sample, a particular advantage for archaeological samples. The examination of trace elements in different teeth allows the trace element exposure of the Asylum children to be examined over three time periods, in utero, before entry to the Asylum and after entry to the Asylum. Extensive analysis of both intra- and inter-tooth variation of trace elements was performed in order to investigate the replicability of trace element analysis using PIGE/PIXE and to determine the extent to which tooth surface selection and tooth type affected the outcome. The relationships between trace element concentrations in the Asylum teeth and osteological stress markers were examined. It is thought that osteological stress markers may occur as a result of malnutrition and/or illness, suggesting that stress indicators may be associated with lower levels of essential elements and possibly a higher toxic element load. The use of PIGE/PIXE to analyse tooth enamel was found to have a number of limitations, most importantly the possible presence of systematic error which impacted on the interpretation of the results. The selection of tooth surface was found to be important and the averaging of the results from a number of teeth of the same type gave the best view of each child’s trace element load. In terms of the children no significant relationships were found between trace elements and the diet of the children either before or after entry to the Asylum. This contradicts the historical records, which suggest the children would have come from a background of malnutrition with improved diet on entry to the Asylum. However, a major finding in this thesis was that iron and zinc, the two most commonly deficient elements in humans, had been altered in the tooth enamel by the post-mortem environment. The other major finding in this thesis was the significant relationship between the high concentration of lead in the Asylum teeth and the degree of cribra orbitalia. The relationship between lead and cribra orbitalia was strongest in the teeth representing life before entry to the Asylum. However other signs of stress such as Harris lines and enamel hypoplasias showed no relationship with lead or any other trace elements. In the future there is clearly value in using trace element analysis to examine the health of the population, particularly in relation to toxic elements. However, it must not be assumed that archaeological teeth are free from post-mortem alteration and it is recommended that future researchers select the elements for analysis with care and examine their samples for post-mortem alteration using a multitude of techniques.

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Vuong, Kylie. "Transforming melanoma prevention: The development, validation and efficacy of model-generated risk predictions in Australian primary care." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17876.

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Personalised model generated risk predictions that incorporate several risk factors may motivate people to increase sun protection. The aim of the thesis is to evaluate and build the quality of the evidence for melanoma risk prediction models, contribute to knowledge of melanoma risk factors for inclusion in risk prediction models, and evaluate their effectiveness as preventive tools inclinical practice. Chapter 1 presents an overview of the epidemiology and role of melanoma risk prediction models in prevention. Chapter 2 presents the results of a systematic review of melanoma risk prediction models. The systematic review identified 28 melanoma risk prediction models. However, there was limited reporting of model development and performance measures, and few studies were externally validated or prospectively evaluated in clinical settings. Chapter 3 evaluates occupational sun exposure and melanoma risk to improve understanding of whether this risk factor should be considered for inclusion in risk prediction models by use of two population based case control studies. There was no association between occupational sun exposure and melanoma risk overall or according to anatomical site. Chapters 4 and 5 presents the development and validation of two melanoma risk prediction models, one using self assessed risk factors and the other using clinicallyassessed risk factors. Chapter 6 presents the results of a pragmatic randomised controlled trial, in which 272 Australian general practice patients were randomly allocated to receive (1) real time personalised model generated risk predictions based on self assessed risk factors and tailored prevention advice, or (2) generic prevention advice. There were no statistically significant differences between intervention and control patients in sun protection practices (p=0.13). However average risk patients in the intervention group appeared to show greater sun protection at 6 weeks (mean difference=0.23, on a scale of 1 to 5; 95% confidence interval: 0.01 to 0.45; p=0.04). This thesis adds high quality evidence relevant to the prevention of me lanoma from the development and validation of model generated risk predictions to their implementation and efficacy in clinical practice and is likely to have an impact on preventative care in Australia and internationally.

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Kelly, Janet, and janet kelly@flinders edu au. "Moving Forward Together in Aboriginal Womens Health: A Participatory Action Research Exploring Knowledge Sharing, Working Together and Addressing Issues Collaboratively in Urban Primary Health Care Settings." Flinders University. School of Nursing & Midwifery, 2009. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20090324.084222.

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This collaborative qualitative research explored ways of improving Aboriginal womens health and well-being in an urban Adelaide primary health care setting. This involved respectful knowledge sharing, working effectively together and addressing issues related to colonisation, discrimination and exclusion. It was identified that while Aboriginal and non-Aboriginal professionals are committed to Closing the Gap in health disparities, many have questioned how best to do so within the current health system. Therefore, this research focused on filling gaps in knowledge about the spaces where Aboriginal community women, and Aboriginal and non Aboriginal health professionals can work collaboratively regardful and regardless of health system polices, programs and practices. A strong commitment to local community preferences and national Aboriginal health research ethics enabled Aboriginal community women and Aboriginal and non-Aboriginal heath professional co-researchers to be actively and meaningfully involved with me in both the research processes and outcomes. A modified Participatory Action Research (PAR), with repeated cycles of Look and Listen, Think and Discuss and Take Action emerged as an effective model of collaborative practice, suitable for health care and research. Four unique yet interconnected areas of collaboration developed, each highlighting particular aspects of culturally safe knowledge sharing and collaboration in health care. The first involved working with Aboriginal community women, acknowledging and addressing their most health and well-being priorities related to high levels of stress in their lives. Collaborative action involved creating a womens friendship group, seeking and accessing a range of services, and co-presenting our findings at conferences The second Collaboration Area offers insights into the practicalities and difficulties experienced by staff as they tried to provide health services for Aboriginal women in a newly developing Aboriginal health organisation. The third Collaboration Area focused on the challenges and benefits of collaboration between sectors, in particular a local high school and the Aboriginal health service. We explored effective ways to work across sectors and engage young Aboriginal women in health programs. The ongoing impact of discrimination, exclusion and colonisation for this next generation of Aboriginal women was highlighted. The fourth Collaboration Area involved wider collaboration and road testing our collaborative methodology in a broader environment. A diverse group of co-researchers came together to plan, implement and evaluate a de-colonising national action research action learning conference embedded in Aboriginal preferred ways of knowing and doing. Findings are discussed under the three central themes of knowledge sharing, working together and addressing health care access and colonisation and key recommendations for the future are proposed. This research has reinforced the need identified in Aboriginal health documents for policy, program and practice commitment to holistic and collaborative approaches such as comprehensive primary health care and participatory action research. While the National Apology and Close the Gap campaign have provided opportunities for change, these need to be followed by tangible action at all levels of health care.

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Paul, David. "Casting shadows and struggling for control : silence, resistance and negotiation in Australian Aboriginal health." University of Western Australia. School of Primary, Aboriginal and Rural Health Care, 2007. http://theses.library.uwa.edu.au/adt-WU2008.0015.

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Self determination has been recognised as a basic human right both internationally and, to an extent, locally, but it is yet to be fully realised for Aboriginal Peoples in Australia. The assertion of Aboriginal community control in Aboriginal health has been at the forefront of Aboriginal peoples' advocacy for self determination for more than thirty years. Aboriginal Community Controlled Health Services and their representative organisations have been the site of considerable resistance and contestation in the struggles involved in trying to improve Aboriginal health experiences. Drawing on some of these experiences I explore the apparent inability of policy and decision makers to listen to systematic voices calling for change from the Aboriginal Community Controlled Health sector. It is government inability to act more fully on clear and repeated messages that is a source of much disquiet within representative Aboriginal organisations. Such disquiet is grounded in a belief that colonial notions continue to influence decision making at policy, practice and research levels resulting in a significant impediment to the realisation of self determination and associated human rights in Aboriginal health matters and Aboriginal Affairs more broadly.

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38

Wynaden, Dianne Gaye. "The primary carer's experience of caring for a person with a mental disorder in the Western Australian community: a grounded theory study." Thesis, Curtin University, 2002. http://hdl.handle.net/20.500.11937/883.

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One in five Australians has a mental disorder and it is estimated that one in four families have a member who has a mental disorder. Since the 1960s there has been an 80 percent decrease in Australian institution-based mental health care. The majority of people who have a mental disorder are now treated in their local community and many of them live with their families. The change in the delivery of mental health care has seen the family emerge as one of the most important supports to their ill family member. While the changes in the delivery of mental health care have been based on human rights concerns, changes in mental health legislature, and economic factors, the multi-dimensional experience of being a primary carer of a person with a mental disorder remains relatively unexplored. The need for empirical evidence on the primary carer's experience is noted in both the scientific literature and from carers themselves and the principal aim of conducting this research was to address the identified need. This qualitative study, using grounded theory methodology, presents the findings of interviews with 27 primary carers and memos documented throughout the study. In addition, existing literature of relevance to the findings of this study is presented. A substantive theory of seeking balance to overcome being consumed is presented in this thesis. Using the grounded theory method the constant comparative analysis of data revealed that the basic social psychological problem shared by all participants was the experience of "being consumed". The problem of being consumed consisted of two stages: "disruption of established lifestyle" and a "sustained threat to self-equilibrium". Six conditions were identified as influencing participants' experience of being consumed.In order to address the problem of being consumed, participants engaged in a basic social psychological process of "seeking balance". When participants were engaged in this process they moved from a state of being consumed to one whereby they established and consolidated a balanced life perspective that incorporated their caregiving role. The process of seeking balance consisted of three phases: "utilising personal strategies to reduce the problem of being consumed', "restoring self- identity", and "reaching out to make a difference". In addition, data analysis identified the presence of a three phase sub-process entitled "trying to make sense of what was happening". Phases one of the core and sub- processes occurred primarily in the period prior to the time when a psychiatric diagnosis was made on the affected family member. Participants became engaged in the remaining two phases of the core and sub-processes when they became aware that their affected family member had a mental disorder. At the time of being interviewed for this study some participants were not yet engaged in the final phase of the process of seeking balance. Participants' experience of seeking balance was not related to the length of their caregiving experience but rather to their experience of seeking balance and the conditions influencing that process. Four conditions were identified as influencing participants' experience of seeking balance.This thesis presents the substantive theory of seeking balance to overcome being consumed. While the findings support existing scientific literature, the substantive theory also presents a new insight on caring from the primary carer's perspective. In particular, the findings challenge health professionals to actively pursue strategies to reduce carers' experience of being consumed. The findings of this study have implications for service provision and clinical practice, policy and planning, research, education, the general population, mental health consumers, and carers.

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39

Lea, Dorothy University of Ballarat. "Spiritual awareness of professional nurses in the western region of Victoria: Investigation of a significant component of holistic heath care." University of Ballarat, 2005. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/12789.

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A desire to more fully understand the impact of altered states of spiritual health on the general health of patients has been a focus of recent research activity. Studies have explored the meaning of spirituality held by patients and nurses, the spiritual needs of patients, and methods of providing spiritual care in nursing. However, few studies have investigated nurses’ own spiritual health and the significance this may have on the provision of holistic nursing care. The aim of this study, therefore, was to inform nursing regarding the spiritual health of nurses and the influence that nurses’ own spiritual health has on their ability to provide holistic nursing care to their patients. The study was conducted in two phases using both quantitative and qualitative methodologies. Phase one consisted of a survey of Division 1 nurses currently employed in the Grampians region of Victoria to describe key dimensions of their spiritual health. This survey provided biographical data and, through the use of the “Shalom Measure of Spiritual Health”, discovered the ideal of spiritual health held by nurses as well as the nurses’ perception of patient needs pertaining to the achievement of spiritual health. Phase two utilised Naturalistic Inquiry to further explore the meaning of spirituality and spiritual health held by nurses, and the methods of achieving these for nurses and patients. The findings revealed that although nurses perceive the spiritual dimension of patient care to be important, they feel ill-equipped to provide this aspect of care. In addition, the major support for nurses, who themselves experience spiritual distress whilst at work, comes from colleagues. Further, prevailing health care systems in place do not always lend themselves to holistic approaches to care. This study identifies the need for nurse education to redress the clearly inadequate preparation nurses are given for this aspect of their role. Health care policy-makers and administrators also have a responsibility to consider all dimensions of care when designing and implementing health care guidelines and systems.
Master of Nursing

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40

Lea, Dorothy. "Spiritual awareness of professional nurses in the western region of Victoria: Investigation of a significant component of holistic heath care." Thesis, University of Ballarat, 2005. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/40615.

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A desire to more fully understand the impact of altered states of spiritual health on the general health of patients has been a focus of recent research activity. Studies have explored the meaning of spirituality held by patients and nurses, the spiritual needs of patients, and methods of providing spiritual care in nursing. However, few studies have investigated nurses’ own spiritual health and the significance this may have on the provision of holistic nursing care. The aim of this study, therefore, was to inform nursing regarding the spiritual health of nurses and the influence that nurses’ own spiritual health has on their ability to provide holistic nursing care to their patients. The study was conducted in two phases using both quantitative and qualitative methodologies. Phase one consisted of a survey of Division 1 nurses currently employed in the Grampians region of Victoria to describe key dimensions of their spiritual health. This survey provided biographical data and, through the use of the “Shalom Measure of Spiritual Health”, discovered the ideal of spiritual health held by nurses as well as the nurses’ perception of patient needs pertaining to the achievement of spiritual health. Phase two utilised Naturalistic Inquiry to further explore the meaning of spirituality and spiritual health held by nurses, and the methods of achieving these for nurses and patients. The findings revealed that although nurses perceive the spiritual dimension of patient care to be important, they feel ill-equipped to provide this aspect of care. In addition, the major support for nurses, who themselves experience spiritual distress whilst at work, comes from colleagues. Further, prevailing health care systems in place do not always lend themselves to holistic approaches to care. This study identifies the need for nurse education to redress the clearly inadequate preparation nurses are given for this aspect of their role. Health care policy-makers and administrators also have a responsibility to consider all dimensions of care when designing and implementing health care guidelines and systems.
Master of Nursing

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41

Lea, Dorothy. "Spiritual awareness of professional nurses in the western region of Victoria: Investigation of a significant component of holistic heath care." University of Ballarat, 2005. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/14624.

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A desire to more fully understand the impact of altered states of spiritual health on the general health of patients has been a focus of recent research activity. Studies have explored the meaning of spirituality held by patients and nurses, the spiritual needs of patients, and methods of providing spiritual care in nursing. However, few studies have investigated nurses’ own spiritual health and the significance this may have on the provision of holistic nursing care. The aim of this study, therefore, was to inform nursing regarding the spiritual health of nurses and the influence that nurses’ own spiritual health has on their ability to provide holistic nursing care to their patients. The study was conducted in two phases using both quantitative and qualitative methodologies. Phase one consisted of a survey of Division 1 nurses currently employed in the Grampians region of Victoria to describe key dimensions of their spiritual health. This survey provided biographical data and, through the use of the “Shalom Measure of Spiritual Health”, discovered the ideal of spiritual health held by nurses as well as the nurses’ perception of patient needs pertaining to the achievement of spiritual health. Phase two utilised Naturalistic Inquiry to further explore the meaning of spirituality and spiritual health held by nurses, and the methods of achieving these for nurses and patients. The findings revealed that although nurses perceive the spiritual dimension of patient care to be important, they feel ill-equipped to provide this aspect of care. In addition, the major support for nurses, who themselves experience spiritual distress whilst at work, comes from colleagues. Further, prevailing health care systems in place do not always lend themselves to holistic approaches to care. This study identifies the need for nurse education to redress the clearly inadequate preparation nurses are given for this aspect of their role. Health care policy-makers and administrators also have a responsibility to consider all dimensions of care when designing and implementing health care guidelines and systems.
Master of Nursing

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42

Mussett, Janis. "An analysis of quality practices and business outcomes in Western Australian hospitals." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2000. https://ro.ecu.edu.au/theses/1651.

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This study aimed at identifying aspects of health care organisational management and activities that produced the highest level of quality care. A Literature review was conducted to determine the most successful quality activities currently used in a wide variety of industries. Using the findings of this review a questionnaire and interview questions were designed to identify factors associated with successful quality activities I health care organisations. Four Western Australian hospitals that were believed to have effective quality activities were randomly selected as a hospital from each of the following categories. A private hospital accredited by the Australian Council on Health Care Standards. A country hospital that had 100% patient satisfaction and a city hospital with above 96% patient satisfaction assessed by the State wide Government Patient Satisfaction with Care Survey. A hospital that the Health Department of Western Australia considered had best practice in Quality Activities. Each of these hospitals was matched with a control hospital. Data was collected through direct observation of a questionnaire and interviews with people in predetermined health service employment positions and the completion of one randomly selected supplier interview for each of the eight health services studied. The questionnaire was supplied to a range of staff members and interviews were conducted with these employees and hospital goods or service suppliers. Data was analysed using qualitative evaluation, frequency distribution and a factor analysis. Results obtained in this study identified that the most important factors required to produce the most profitable and highest quality of health care were a culture of caring, providing employees with enough time to complete their work and having effective organisation wide communication. A Quality Care Model for use in Health Services was created based on the research findings. When used this model of quality activities should provide customer satisfaction and a high standard of cost effective health care service.

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Nicholas, Jennifer. "The roles and responsibilities of WA general practice nurses in diabetes care and management." Thesis, Curtin University, 2009. http://hdl.handle.net/20.500.11937/1313.

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The rising incidence of chronic diseases such as diabetes, associated comorbidities, an ageing population and rising health expenditure are all creating a greater burden on the Australian health care system.Purpose of the Study. The role of the practice nurse (PN) working within the general practice setting is expanding in response to health care demands and government policies, yet there is a lack of Australian research into how this role may impact upon the management of diabetes. This study explores current practice of PNs, their diabetes specific education, and driving and restraining forces that influence their involvement in diabetes management.Methodology. A cross sectional design with a postal survey, whereby 758 surveys were distributed to PNs via each of the 13 Western Australian Divisions of General practice, between October 2006 and May 2007. The final response rate was 16% (n = 118) with 118 surveys completed and returned. The Statistical Package for Social Sciences 15.0 was used for data entry and analysis.General Practice Setting. In the current study 85% (n = 94) of practices had a diabetes register, with 75% (n = 83) of PNs involved in operating this system. The PN has a defined role in contributing towards the development of chronic disease care plans and annual diabetes complication screening processes, services that are reimbursed through Medicare. However, current models of primary care delivery and funding appear to support the PN in this role as an adjunct to the general practitioner (GP), which may not permit full utilisation and recognition of the PNs’ professional scope of practice.The Role of the Practice Nurse. A statistically significant association was found between those PNs having completed diabetes related continuing education and the greater likelihood of providing education in insulin initiation, blood glucose monitoring, dietary advice, exercise and sick day education (p < .05). Whilst PNs in the current study displayed a high level of involvement in various areas of diabetes care, not all will be educationally prepared, yet may be undertaking what could be considered a more advanced practice role in diabetes self management education.Diabetes Knowledge Test. There was significantly higher scoring in the Diabetes Knowledge Test (DKT) where questions related to insulin therapy, amongst those PN’s with a role in providing education in self monitoring of diabetes (p = .036). Likewise, where the provision of dietary advice was part of the PN role, scoring was significantly higher in the DKT overall (p = .029). For those spending greater than two hours per week in diabetes related care, scores were significantly higher where questions examined principles surrounding management of blood glucose levels (p = .031). Practice nurses having undertaken a clinical audit related to diabetes care, scored significantly higher in the DKT overall (p = .037), particularly where those questions related to the complications associated with diabetes (p = .009).Barriers and Facilitators to PN Role in Diabetes Self Management Education. Practice nurses in the current study placed a significantly high level of importance on their role in patient teaching. However, time was found to be a significant barrier to this role (p < .05). The current study displays a high level of involvement by PNs in various areas of diabetes self management education and related clinical assessment, with a low level of involvement in diabetes specific continuing formal education. Whilst this facet of their role has more recently been acknowledged within general practice guidelines for diabetes management, the question remains as to the level of educational preparedness of the PN, to meet this expanding role.

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Smith, Allan. "The psychological wellbeing, health-related quality of life (HRQOL), and supportive care needs of Australian testicular cancer survivors: a quantitative and qualitative investigation." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/12806.

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Testicular cancer (TC) is one of the most common malignancies in young men aged 15 to 35 years. This thesis provides a comprehensive evaluation of the prevalence, severity, and correlates of psychological distress, impaired HRQOL, and supportive care needs in TC survivors. Men who had completed active treatment for TC 6 months to 5 years previously with no evidence of recurrence were recruited from 14 Australian cancer centers (September 2009 – February 2011). Of 486 eligible TC survivors, 244 (50.2%) completed a self-report questionnaire measuring psychological distress (DASS21), generic HRQOL (SF-36v2), TC-specific HRQOL (EORTC QLQ-TC26), adjustment style (MAC), social support (DUFSS), and unmet needs (CaSUN). A further 24 men completed in-depth interviews. Participating TC survivors reported impairments to several more mental aspects of generic and cancer-specific HRQOL compared with the general population and TC survivors from other countries respectively. The most problematic TC-specific HRQOL issues were similarly more mental than physical. A significantly greater proportion of TC survivors also reported clinical anxiety/depression relative to the general population. It is notable that only certain HRQOL domains were impaired in TC survivors and only a subgroup had clinically relevant psychological morbidity. The number of TC survivors with strong unmet needs was also relatively small; the most prevalent unmet needs related to existential and relationship issues. This highlights the need to identify TC survivors at risk of poorer outcomes and for interventions to target the areas of greatest impairment, rather than routinely offering generic interventions. Men’s subjective perceptions of the impact of TC seem to be more closely related to their HRQOL and psychological wellbeing than objective disease and treatment factors. Men who: are younger, are not well informed about TC, experience job problems, suffer from FCR, have low social support, and are helpless-hopelessness or avoidant copers are at greatest risk of poor outcomes. Some TC survivors may be reluctant to undertake traditional forms of psychological treatment (i.e. face-to-face psychotherapy). Alternative ways of supporting TC survivors (e.g. Internet resources) may be more accessible, cost effective, and less stigmatised.

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45

Wynaden, Dianne Gaye. "The primary carer's experience of caring for a person with a mental disorder in the Western Australian community: a grounded theory study." Curtin University of Technology, School of Nursing and Midwifery, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=15910.

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One in five Australians has a mental disorder and it is estimated that one in four families have a member who has a mental disorder. Since the 1960s there has been an 80 percent decrease in Australian institution-based mental health care. The majority of people who have a mental disorder are now treated in their local community and many of them live with their families. The change in the delivery of mental health care has seen the family emerge as one of the most important supports to their ill family member. While the changes in the delivery of mental health care have been based on human rights concerns, changes in mental health legislature, and economic factors, the multi-dimensional experience of being a primary carer of a person with a mental disorder remains relatively unexplored. The need for empirical evidence on the primary carer's experience is noted in both the scientific literature and from carers themselves and the principal aim of conducting this research was to address the identified need. This qualitative study, using grounded theory methodology, presents the findings of interviews with 27 primary carers and memos documented throughout the study. In addition, existing literature of relevance to the findings of this study is presented. A substantive theory of seeking balance to overcome being consumed is presented in this thesis. Using the grounded theory method the constant comparative analysis of data revealed that the basic social psychological problem shared by all participants was the experience of "being consumed". The problem of being consumed consisted of two stages: "disruption of established lifestyle" and a "sustained threat to self-equilibrium". Six conditions were identified as influencing participants' experience of being consumed.
In order to address the problem of being consumed, participants engaged in a basic social psychological process of "seeking balance". When participants were engaged in this process they moved from a state of being consumed to one whereby they established and consolidated a balanced life perspective that incorporated their caregiving role. The process of seeking balance consisted of three phases: "utilising personal strategies to reduce the problem of being consumed', "restoring self- identity", and "reaching out to make a difference". In addition, data analysis identified the presence of a three phase sub-process entitled "trying to make sense of what was happening". Phases one of the core and sub- processes occurred primarily in the period prior to the time when a psychiatric diagnosis was made on the affected family member. Participants became engaged in the remaining two phases of the core and sub-processes when they became aware that their affected family member had a mental disorder. At the time of being interviewed for this study some participants were not yet engaged in the final phase of the process of seeking balance. Participants' experience of seeking balance was not related to the length of their caregiving experience but rather to their experience of seeking balance and the conditions influencing that process. Four conditions were identified as influencing participants' experience of seeking balance.
This thesis presents the substantive theory of seeking balance to overcome being consumed. While the findings support existing scientific literature, the substantive theory also presents a new insight on caring from the primary carer's perspective. In particular, the findings challenge health professionals to actively pursue strategies to reduce carers' experience of being consumed. The findings of this study have implications for service provision and clinical practice, policy and planning, research, education, the general population, mental health consumers, and carers.

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Murphy, Angela University of Ballarat. "When urban policy meets regional practice : Evidence based practice from the perspective of multi-disciplinary teams working in rural and remote health service provision." University of Ballarat, 2004. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/12747.

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"In the main, contemporary research on Evidence Based Practice (EBP) has taken place within metropolitan locations, and has offered urbocentric solutions and insights. However the transferability of these developments to rural services is untested empirically. In addition, evidence development and studies on the implementation of this evidence have tended to be discipline-stream-specific; there has been very little research into either the development of multi-disciplinary evidence guidelines or the implementation of EBP from the perspective of individual practitioners working within multi-disciplinary teams. This research shortfall has provided the rationale for this study...."
Doctor of Philosophy

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47

Murphy, Angela. "When urban policy meets regional practice : Evidence based practice from the perspective of multi-disciplinary teams working in rural and remote health service provision." Thesis, University of Ballarat, 2004. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/67365.

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Abstract:

"In the main, contemporary research on Evidence Based Practice (EBP) has taken place within metropolitan locations, and has offered urbocentric solutions and insights. However the transferability of these developments to rural services is untested empirically. In addition, evidence development and studies on the implementation of this evidence have tended to be discipline-stream-specific; there has been very little research into either the development of multi-disciplinary evidence guidelines or the implementation of EBP from the perspective of individual practitioners working within multi-disciplinary teams. This research shortfall has provided the rationale for this study...."
Doctor of Philosophy

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48

Murphy, Angela. "When urban policy meets regional practice : Evidence based practice from the perspective of multi-disciplinary teams working in rural and remote health service provision." University of Ballarat, 2004. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/14586.

Full text

Abstract:

"In the main, contemporary research on Evidence Based Practice (EBP) has taken place within metropolitan locations, and has offered urbocentric solutions and insights. However the transferability of these developments to rural services is untested empirically. In addition, evidence development and studies on the implementation of this evidence have tended to be discipline-stream-specific; there has been very little research into either the development of multi-disciplinary evidence guidelines or the implementation of EBP from the perspective of individual practitioners working within multi-disciplinary teams. This research shortfall has provided the rationale for this study...."
Doctor of Philosophy

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49

O'Meara, Carmel M., and n/a. "Childbirth and parenting education in the ACT: a review and analysis." University of Canberra. Education, 1990. http://erl.canberra.edu.au./public/adt-AUC20060710.161652.

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The study reviewed the provision of childbirth and parenting education in the ACT for indicators of effectiveness and needs. Users (n = 207) and providers (n = 7) were surveyed for information on educational and administrative aspects of the service. An original design questionnaire was based on the PRECEDE framework (predisposing, reinforcing and enabling factors in educational diagnosis and evaluation) and the social model of health. Items were drawn from the relevant literature, concerning individual, social and service delivery elements of the health fields concept interpreted for pregnancy, childbirth and parenting. Individual factors were related to Maslow's hierarchy and the valuing approach to health education. The provider survey covered information on organisational elements, comprising inputs, processes, products, outputs and outcomes of childbirth education. The study comprised a literature review, cross-sectional non-experimental surveys of users and providers, and a needs assessment combining information from each of the three sources. Descriptive statistical techniques, analysis of variance and valuing analysis were used to extract information on effectiveness indicators and needs from the user data. Comparisons were made between present and past users, and between women of different ages, experience of pregnancy and preferences for public or private methods of education for childbirth. No evidence was found of individual differences in the women's attitudes, beliefs and values that could be attributed to education. However, users expressed strong approval and positive views of the service and its providers. The level of personal health skills, confidence and emotional preparatiqn they achieved through childbirth and parenting education did not fully meet their expectations. The survey also found that the organisation of childbirth and parenting education has not developed professionally like other health services. Service goals and objectives are ill-defined; planning and coordinating are inadequate for an integrated maternal health care system. The service's main resources are its highly motivated and dedicated teachers and clients. Several recommendations are made for educational and administrative measures to enhance service effectiveness within present organisational constraints, based on the needs identified by the study.

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50

Bell, Francesca A. "The requirement to be fit and proper: What does it mean to Australian psychologists?" Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2015. https://ro.ecu.edu.au/theses/2072.

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The phrase fit and proper is used in the Health Practitioners Regulation National Law Act (Qld), 2009, which came into effect nationally in 2010 and governs psychologists. As with previous legislation that used the phrase, the legislator does not define fit and proper, leaving it up to each profession to determine its exact meaning and inform the courts accordingly. A review of the literature established that to date no Australian psychologist has attempted to define the construct. This means that Australian lawyers do not get any guidance from psychologists regarding how they should interpret the phrase fit and proper in relation to psychologists. Ideally, however, the beliefs of psychologists as a group should inform any definition of what constitutes a fit and proper psychologist. In the absence of such research, the purpose of this study was to determine Australian psychologists’ understanding of the construct. During Stage One, semi-structured interviews with 16 Western Australian psychologists explored what they considered constituted a fit and proper psychologist. Using a grounded theory approach, the data analysis revealed 2 superordinate components to fitness and propriety. Participants believed that a fit and proper psychologist had 11 person features. These person features could be split into 3 categories, namely capability, character, and conduct. The second component, termed system issues contained the categories of selection and screening, monitoring, regulation, and prevention and remediation. The aim with Stage Two was to determine whether other Australian psychologists agreed that the 11 person features described a fit and proper psychologist, and if they did, how they ranked them. A cognitive interviewing strategy was employed to add rigour to the design of a questionnaire and to provide confirmation of the person features constructed from the Stage One interviews. The cognitive interview process established that 2 of the original 11 person features were too broad. As a result, both of these features were split into two, giving a total of thirteen person features that were included in the questionnaire. A representative sample of 226 Australian psychologists completed the questionnaire that collected both qualitative and quantitative data. Participants classified 8 features as critically important and 5 as important features of a fit and proper psychologist, with self-awareness ranked as the most important feature. An analysis of the qualitative data revealed a third superordinate component, termed moderators. Moderators, such as impact on practice, alter each person feature from a black and white concept to a nuanced and more complex one. Moderators build flexibility into the person features and allow for the role of each in fitness and propriety to alter according to a psychologist’s life stage and circumstance. Australian psychologists believe that a fit and proper psychologist exists in a professional system comprising psychologists themselves and bodies that perform a variety of functions related to the establishment, development, and regulation of standards in the profession. A fit and proper psychologist possesses 13 key person features that can be maintained because of moderating factors. This understanding has implications for psychologists, service users, regulators, and the judiciary.

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Dissertations / Theses on the topic 'Australian health care'

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