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1
Patterson, Jan. "Consumers and complaints systems in health care /". Title page, contents and summary only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09php3174.pdf.
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2
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.
Texto completo da fonteResumo:
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.
3
Wright, Trudy, e n/a. "Primary health care : the health care system and nurse education in Australia, 1985-1990". University of Canberra. Education, 1994. http://erl.canberra.edu.au./public/adt-AUC20061110.171759.
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Primary health care as a model for the provision of health services was
introduced by the World Health Organization In the mid 1970s. Initially
viewed as a means of health promotion and advancement of wellness in
developing countries., it was soon to be adopted by industrialised countries to
assist in relieving the demand on acute care services. This was to be achieved
through education of the community towards good health practices and the
preparation of nurses to practice in the community, outside of the acute care
environment Australian nurses were slow to respond to this philosophy of
health care and this study has sought to examine why this is so. It has been
found that there are a multitude of reasons for the lack of action In the decade
or more following the Declaration of Alma Ata and the major Issues have been
identified and elaborated.
Some of the major reports of the time that were associated with and had some
Influence on health care and nurse education have been examined to identify
recommendations and how much they support the ethos of primary health
care. These include the Sax committee report of 1978 and a submission by
the Department of Employment and Industrial Relations In 1987.
As part of the investigation, nursing curricula from around Australia in the
mid 1980s have been examined to determine the degree of the primary health
care content according to guidelines recommended by the World Health
Organization. It was found that generally at that time, there was a deficit In
the preparation of undergraduate students of nursing for practice In the area
of primary health care when the world, including industrialised nations, was
making moves towards this model of health care delivery.
Factors Influencing the slow response of nursing have been examined and
finally recommendations for further studies have been put forward.
4
Sinclair, Andrew. "The primary health care experiences of gay men in Australia". Connect to this title online, 2006. http://adt.lib.swin.edu.au/public/adt-VSWT20060713.084655/.
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5
Crawford, Gregory Brian, e gregory crawford@adelaide edu au. "Depression in palliative care patients in Australia: identification and assessment". Flinders University. Medicine, 2008. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20090127.133003.
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Depression is poorly recognised, under-assessed and under-treated in patients receiving palliative care for a life-limiting illness. There are barriers to assessment and diagnosis, and limited access to specialist clinicians who might assist in these complex assessments and who could provide options for treatment.
The three studies presented, using different research methodologies, and using both qualitative and quantitative analysis, seek to clarify these issues and to provide some solutions. A questionnaire was sent to all Palliative Care Services (PCS) in Australia. Questions included what part specialist psychological clinicians played in multi-disciplinary team meetings and in the treatment or coordination of patient care. Very few PCS used a valid screening instrument for psychological distress and very few had regular support from a psychiatrist or psychologist. Many did not have access to social work support.
There are two competing issues with regard to recognising and assessing depression in palliative populations. A rapid reliable screen that points to a likely problem would be useful, but also there is a need to understand something of the patient experience of depression.
In the second study, the one- and two-item screening instruments widely used in palliative care are examined and limitations that have been found in other settings are confirmed. A new novel screening tool is developed from this data and tested empirically. This algorithm is short, has good psychometric properties and is validated for an Australian palliative care population. Depending on the response pattern it is possible to identify that a particular patient has significant symptoms of depression by asking between one and four questions. Professional carer and patient acceptability of the questions is high.
The understanding of the experience and symptom profile of depression in Australian palliative care patients is addressed in the third study. Patients and family carers were recruited prospectively from palliative care and oncology ambulatory clinics of two teaching hospitals in an Australian capital city. The Geriatric Depression Scale (GDS) was administered to the patient and the Collateral Source version of this instrument was asked of the carer. A subset of this sample completed the measures twice. The results using this 30-item scale were then compared with all the known previously published short versions of this scale. Two short forms met as many psychometric criteria as the longer forms. None of the versions of the GDS showed sufficiently high correlations between carer-completed and patient-completed forms. The frequency of symptoms was also assessed. Patients more frequently reported fatigue and anhedonia than depressed affect.
Despite many screening instruments being available for depression, their use is limited in Palliative Care Services. Although these studies have validated several options for Australian palliative care patients, the issues behind the low uptake rates for screening have not been resolved. The final chapter of this thesis constructs known and potential barriers into a logical structure and then offers some solutions to improve access to mental health professionals by considering service models and applying this theory to the problem of depression and its assessment in palliative care populations.
6
Sinclair, Andrew James, e n/a. "The primary health care experiences of gay men in Australia". Swinburne University of Technology, 2006. http://adt.lib.swin.edu.au./public/adt-VSWT20060713.084655.
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The present research, consisting of two studies, was designed to examine the
primary health care experiences of gay men in Australia and assess doctors? attitudes and
training with regard to gay men and their health care. In the first study, 195 gay men were
surveyed regarding their health issues and their primary health care experiences. The
most important health concerns of gay men were stress and depression followed by
HIV/AIDS, body image disorder and other sexually transmissible infections. Including
those participants who were unsure, approximately one-half reported experiencing
homophobia and almost one?quarter reported experiencing discrimination in the
provision of health care. Despite this, respondents were generally satisfied with their
primary health care, although respondents felt that all GPs should receive additional
undergraduate medical education regarding gay men?s health. In the second study, 25
doctors (13 gay specialists and 12 non-gay specialists) were surveyed regarding their
knowledge of gay men?s health and their comfort working with gay men. Non-gay
specialist GPs were less comfortable treating gay men, reported poorer communication
and were more homophobic than their gay specialist counterparts. Further, doctors
perceived their medical education regarding gay men?s health has been inadequate.
Together, the results of the two current studies suggest that disclosure of sexuality is an
important issue for both gay men and doctors, and has the potential to impact on the
quality of health care that gay men receive. In order to improve the level of disclosure,
the pervasiveness of homophobia and discrimination in primary health care must be
reduced. Finally, the results indicate that medical education must be updated to reflect
current knowledge regarding the health issues of gay men. Failure to address these issues
will condemn gay men to continued health inequality.
7
Pasolli, Kelly E. "Policy legacies and child care politics in Australia and Canada". Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/101806.
Texto completo da fonteResumo:
Thesis: S.M., Massachusetts Institute of Technology, Department of Political Science, 2015."September 2015." Cataloged from PDF version of thesis.
Includes bibliographical references (pages 58-63).
This study explores the puzzle of why Australia and Canada have followed significantly different paths in national-level child care policy despite their otherwise similar welfare state structures. Australia has developed a relatively generous system of public subsidies to support the provision of care for young children, while at the same time relying increasingly on the market to deliver child care. In contrast, Canada has extremely low levels of public spending and service provision, resulting in a less expansive system of regulated child care. I trace these divergent outcomes to the impact of post-WWII child care policy legacies in these countries and the way that these legacies interact with the changing politics of the welfare state to produce variation. In Canada, child care policy was first established within a social assistance framework as a service intended to combat poverty, while in Australia, child care was introduced as an economic policy to facilitate women's workforce participation. The differences in the intended goals of these policies affected the subsequent patterns of child care politics and policy development in these two countries, leading to the divergent outcomes observed today.
by Kelly E. Pasolli.
S.M.
8
Haghshenas, Abbas Public Health & Community Medicine Faculty of Medicine UNSW. "Negotiating norms, navigating care: the practice of culturally competent care in cardiac rehabilitation". Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/32280.
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BACKGROUND Increasingly, it is recognised that the unique needs of people from culturally and linguistically diverse backgrounds (CaLDB) should be addressed within a framework of cultural competence. To date, there are limited data on the issues facing CaLDB patients in the Cardiac Rehabilitation (CR) setting. Appreciation of an individual???s values, attitudes and beliefs underpins negotiation of behaviour change in the CR setting. Therefore an understanding of patient and professional interactions is of key importance. OBJECTIVES The focus of this study has been to undertake an exploration of CR service delivery to people from culturally and linguistically diverse backgrounds, using Arabic speaking people as an exemplar of a CaLDB group. More broadly, this research project has sought to identify factors, which influence the practice of health professionals towards CaLDB patients, and to develop a model for evaluation of culturally competent health care in the CR setting. The study sought to achieve these aims by addressing the following research questions: 1. In what way do health practitioners in CR adjust their treatment and support to accommodate the perceived needs of CaLDB communities? 2. In what way do factors (such as individual and organisation perspectives) influence the adjustment of clinical practice and service delivery of CR practitioners; and what are practitioners??? and patients??? perception of barriers and facilitators to service delivery? 3. To what level are CaLDB patients satisfied with CR services? This study design is comprised of the following elements: (1) interviews with health practitioners and Arabic speaking background patients as an exemplar of CaLDB patients; (2) review of policy and procedure documents and medical records; and (3) field observation. METHOD This thesis embraces a qualitative approach as the primary method of investigation to align with the exploratory and descriptive nature of the study. The main methods used in the study were: in depth interviews with health professionals and patients; field observations; appraisal of relevant documents and consultation with expert panels. Study samples were selected through a purposive sampling strategy.Data were analysed using the method of content analysis, guided by the research questions. FINDINGS In total, 25 health professionals (20 female and 5 male) and 32 patients (21 male and 11 female) were interviewed. The method of qualitative content analysis was used for data analysis. Data analysis revealed four major themes: 1) The challenging context; 2) Tuning practices; 3) Influencing factors; and 4) Goodness of fit. The study demonstrated a challenging context for CR delivery, both from the perspective of patients and health professionals. Data reveal a process of reflection, negotiation, and navigation of care by CR health professionals in an effort to understand and meet the diverse needs of CALDB patients. CONCLUSION On the basis of the study findings, a process-oriented model of tuning practice to achieve cultural competence in CR delivery is proposed to inform policy, research and clinical practice.
9
McNamara, Laurence James. "Just health care for aged Australians : a Roman Catholic perspective /". Title page, contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09PH/09phm1682.pdf.
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10
Kingsley, Elizabeth J. S. "Articulating and ameliorating elder abuse in Australia". Curtin University of Technology, School of Nursing, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=13966.
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The abuse of older people is a largely unrecognised and under acknowledged social problem in Australia. My major objective in undertaking the work, which is represented by the original published articles that comprise the thesis, was to make a scholarly and practical contribution toward the minimisation of 'elder abuse. This objective was achieved with the development and implementation of a series of studies that articulated and ameliorated elder abuse in Australia.The thesis provides an erudite synthesis of these studies, which fall into four themes that illustrate the nature and scope of my theoretical and professional work in elder abuse. Much of the work was guided by a conceptual framework of ways of knowing in nursing, and was underpinned by the principles and practice of community development and participatory community-based action processes.The outcomes of these studies include work with three stakeholder groups: professionals who deal with elder abuse, older people who are victims or potential victims of abuse, and those who perpetrate abuse on an older person. The work, illustrated in the four themes, includesthe articulation of elder abuse issues with West Australian aged care workersthe development of elder abuse protocols, policy guidelines and ethical principles, to guide professional practice in abuse prevention and interventionthe design and implementation of participative community programs to empower older people, and their carers, to resist being abused or abusing and to assist perpetrators stop their abusethe amelioration of abuse of nursing home residents by staff.The thesis situates my conceptual and clinical effort within the wider corpus of Australian knowledge and practice on elder abuse and contributes to addressing the social problem of elder abuse within the context of Australian aged care.
11
McGuiness, Clare Frances. "Client perceptions : a useful measure of coordination of health care". View thesis entry in Australian Digital Theses Program, 2001. http://thesis.anu.edu.au/public/adt-ANU20020124.141250/index.html.
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12
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.
13
Scott, Jane A. "A study of the present and potential contribution of dietitians to health care in Australia". Curtin University of Technology, School of Community Health, 1987. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=11642.
Texto completo da fonteResumo:
This study was undertaken to determine the present and potential contribution of dietitians to health care in Australia. Data were collected from three separate surveys conducted over a 15 month period from September 1984 to December 1985. The first survey, a National Workforce survey, provided a profile of the demographic and employment characteristics of the dietetic profession in Australia. The second survey was undertaken to determine the role of the dietitian as perceived by dietitians themselves and in the third survey a group of general practitioners was surveyed to determine what they perceived to be the role of the dietitian and to what extent they utilised the services of dietitians.Results of the surveys suggest that dietitians in Australia are not realising their full potential contribution to health care. Firstly, there are too few dietitians in Australia and it is unlikely, despite the best intentions, that the profession will be able to meet consumer need and demand for nutritional care and education. There was considerable disparity between what dietitians considered to be their ideal role versus their actual role. Role disparity among dietitians was highest for professional development, education and research activities and low or moderate for nutritional care activities. A lack of time was most frequently cited as the major deterrent preventing dietitians performing activities which they perceived to be part of their ideal role.The results of the third survey indicated that in general, the doctors surveyed had favourable opinions of dietitians but that they held rather traditional views of the role of the dietitian, expecting them to be more involved in food preparation and service than dietitians expected to be. This general lack of awareness of the role and expertise of dietitians and their potential contribution to health care is likely to lead ++to an under- utilisation of the full range of services provided by dietitians as evidenced by this study.
14
Jewell, Trevor. "Martu tjitji pakani : Martu child rearing and its implications for the child welfare system". University of Western Australia. Social Work and Social Policy Discipline Group, 2009. http://theses.library.uwa.edu.au/adt-WU2009.0147.
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In this research, I explore my belief that one the reasons for the continuing poor outcomes for Indigenous people was that State-wide and national programs ignored unique local Indigenous culture and did not actively involve local Indigenous people in the development of programs for their area. I chose to examine this perception through investigation of the tension between Indigenous culture and worldview and the dominant White values of the child welfare system (broadly defined), through description of Martu child rearing practices and beliefs in the remote Western Australian town of Wiluna. The Martu live in a remote environment of material poverty, high levels of unemployment, low levels of educational achievement and poor health outcomes. The research sponsored by the Ngangganawili Aboriginal Health Service and located in its Early Childhood Centre, uses an Indigenous research approach based on Brayboy's (2005) TribalCrit to explore Martu child rearing practices, beliefs and values. It uses the stories told by the Martu in Wiluna about the way they and their families were brought up and observations of Martu families to answer research questions around Martu definitions of children and families, their concerns for their children, ways of ensuring the well being of their children, and whether there is a Martu child welfare approach. The research then considers the implications of these Martu practices for the broadly defined child welfare system. The stories told by the Martu show that they have a unique way of bringing up their children that is different to those in the dominant White culture. This uniqueness is derived from a combination of the recent colonisation of the Martu, their culture and their post colonisation experiences. The implications of Martu child rearing for the child welfare system are based on the assumption that Martu are wholly dependent on poorly designed and targeted government provided or funded services, and the current ways of delivering these services is failing the Martu. The research concludes that the key to improving outcomes for Martu children and their families is for the agencies delivering these services to form close working relationships with the Martu; operate within, understand, appreciate, and respect Martu Law and culture; understand their (personal and agency) and Martu post colonisation histories; and allow for Martu control, definition of priorities and development of strategies to address the problems.
15
Wilson, Sally B. "Family Centred Care: A Descriptive Study of the Situation in Rural Western Australia". Curtin University of Technology, School of Nursing and Midwifery, 2004. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=15170.
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Family centred care is a concept espoused to be fundamental to achieving excellence in paediatric nursing. Although it is recognised that family centred care includes the child's rights to self determination the focus of this study is parental participation in the decision making and care of their hospitalised child at a partnership level. This is based on negotiation and requires frequent, effective communication between parents and nurses and for each to respect the other's knowledge and appreciate the other has something to offer in the relationship which will benefit the child. The purpose of this study was to identify whether family centred care was occurring in paediatric settings in rural Western Australia and explored parents' and nurses' perceptions of the concept. A questionnaire was designed based on the literature and common themes identified from focus groups. Convenience sampling was used and 15 rural hospitals facilitated participation of 243 parents who had a child under ten years of age hospitalised and 108 nurses who cared for children. Exploratory factor analysis identified four subscales from the parents' questionnaire and three subscales from the nurses' questionnaire which measured separate concepts of family centred care. Descriptive statistics were generated for each subscale, and independent t-tests, ANOVA and correlations were examined between independent variables and subscales of family centred care. There was a statistically significant difference in scores for parents' perceptions of `child friendly environment' between regional and district hospitals. Those parents who did not have social support scored a statistically significantly lower mean score for `respect as parent'. Nurses in district hospitals generated statistically significantly higher mean scores for `family focussed hospital' than those who worked in regional hospitals.Parents and nurses both perceived that parents wanted to continue parenting their hospitalised child, however parents wanted to provide more nursing care than was perceived by nurses. Nurses' perceptions of delivering family centred care were greater than the perceptions of parents receiving it, however they were consistent in items that were scored low. Nurses did ask parents about the amount of participation they wanted in their child's care on admission however, it was not done on a regular basis. Parents perceived that nurses were unaware of other things that parents needed to attend to while their child was hospitalised and therefore did not enable parents to attend to these needs. More frequent negotiation of roles between parents and nurses by communicating each shift, or at least daily, could narrow the gap between differing perceptions in care provision and also enable parents to attend to their other roles thereby reducing their levels of physical and emotional stress.
16
Sukkar, Khalil Hassan, e mudeer@optusnet com au. "The prospects of Adopting Alternative Staffing Methods in Residential Aged Care in Australia". RMIT University. Graduate School of Business, 2009. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20091005.115238.
Texto completo da fonteResumo:
The Residential Aged Care (RAC) industry is the fastest growing sector of the health care industry in Australia, particularly with the needs of people aging eighty five years and over consuming most health care services (Productivity Commission, 2006). This thesis examines the staffing efficiency challenge that is facing the RAC industry in Australia, from the facility managers' perspectives. Staffing efficiency is a crucial component in the success of this industry that is labour intensive, delivering complex services twenty-four hours per day and seven days per week. By achieving staffing efficiencies, facility managers would minimise labour cost expenditures; thus, ensuring sustainability and growth of their organisation in the long run. The literature reviewed revealed limited number of scholarly reviews about staffing efficiencies conducted in Australia. Nevertheless, it highlighted a number of available staffing approaches available overseas which could be of promising results if they were adopted to suit the Australian industry and its operational systems. This thesis explores the prospects of RAC facility managers adopting 'alternative' or 'new' staffing methods in their facilities as one solution for this staffing challenge. In this study, the researcher refers to alternative or new staffing methods as staffing methods that are not currently utilised in the staffing of RAC facilities in Australia. Using an Interpretivist research paradigm, 18 semi-structured interviews were conducted with the participating RAC managers in their work environment. During the interviews, a sample alternative staffing tool, developed prior to the study, was displayed. The data generated were analysed in the context of the RAC industry's environment, operational challenges, and through the theoretical implication of neo-liberalism. This theory provided a vehicle for the analysis of the data generated on staffing within the context of Australia's current economic policies. The generated data revealed little chance of such adoption reflected in a number of findings including: 1) Participants' lack of interest in adopting alternative staffing methods despite their comments on the unsuitability of current tools. 2) Overdependence of the industry on cost cutting measures and monetary performance indicators. 3) Lack of incentives for the adoption of change and 4) Lack of preparedness of RAC facility managers for such change. Thorough analysis of the findings revealed misinterpretation of free-market principles in the currently utilised staffing tools, which links demand of service to the number of individuals requiring care on one hand, and the supply of services available to the number of staff rostered to provide the care, on the other hand. The application of such a principle on the RAC industry is questionable, particularly with the inconsistency in the elderly residents' care needs and the staffing skill mix. A new staffing approach that uses the care required by the elderly individuals and the staffing skills available in the facilities as the basis for the demand and supply principles will provide a plausible solution for facing the staffing challenge. A joint venture between the Australian government and the RAC industry to encourage the adoption of such alternative staffing approach is the recommended way forward for improving staffing efficiencies.
17
Henderson, Saraswathy. "The phenomenon of patient participation in their nursing care : a grounded theory study". Curtin University of Technology, School of Nursing, 1998. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=10574.
Texto completo da fonteResumo:
In recent times there has been an emphasis on patients participating in their own nursing care. Studies have demonstrated that when patients participate in their own care, they experience positive outcomes, such as greater satisfaction with care, a sense of control, decreased vulnerability, and being effectively prepared for discharge. Practising nurses are of the view that patients should be involved in the planning, implementation, and evaluation of care in keeping with nursing's philosophy of provide holistic or patient-centred care. Despite this there is literature to show that nurses' espoused pro-participatory attitudes were not always enacted in the practice setting. There was a paucity of research to explain why this situation existed. Therefore, the purpose of this grounded theory study was to explore, describe, and analyse nurses' and patients' perspectives on the phenomenon of patient participation within the context of hospital nursing practice in Western Australia.Data were collected through formal and informal interviews with nurses, patients, non nurses, a doctor and relatives, focus group interview with nurses, participant observation, listening to nurses' handovers, examination of nurses' notes, and published literature. Thirty three Registered Nurses and 32 patients from medical, surgical, and extended care wards were formally interviewed. Additionally, 28 nurses and 17 patients were informally interviewed during participant observation. The total hours of participant observation was 142. The constant comparative method was used to analyse the data.The findings revealed that the basic social problem that faced nurses and patients was incongruence in their understandings of the meaning of patient participation and in their philosophies about nursing care. This had led to nurses and patients adopting three styles of participation, that is, ++participation inclusion which involved patients participating in all aspects of their care, including making decisions about their treatments, participation marginalisation which encompassed patients participating only in their daily living activities and pain management, and participation preclusion which involved patients not participating in any aspects of their care. This resulted in nurses and patients coming together with their own different styles of patient participation, which caused conflict in viewpoints about how care should be provided and received at the bedside. Exacerbating the problem of incongruence were the hospital contextual conditions of economic constraints, management structures, presence of technology, and culture of medical dominance. These contextual conditions also modified the process that nurses and patients used to deal with the problem.The basic social process that nurses and patients used to deal with the problem of incongruence was labelled accommodating the incongruence and involved three phases. It was found that varying intervening conditions that affected the nurses, patients, or both, and the day-to-day ward environment modified this process. The first phase, which was labelled coming to terms with the incongruence, involved nurses and patients encountering and acknowledging that there was an incongruence. The second phase, which was termed rationalising the incongruence, involved nurses and patients observing and assessing each other's behaviours. The third phase, which was labelled seeking resolution: minimising the incongruence, involved nurses and patients adjusting their behaviours so as to achieve some balance. This third phase was nurse-driven with patients playing a subsidiary role. This was considered to be due to nurses being at their optimum physical level of functioning and in their own socio-cultural work ++
environment as opposed to patients who were ill and therefore vulnerable. Nurses adjusted their behaviours, depending on the patients' preferred style of participation, by either increasing patients' control and level of participation, as well as increasing their own level of control, to upgrade patients' input; or decreasing patients' control and level of participation and decreasing their own level of control to downgrade patients' input; or alternatively converging patients' control and level of participation to meet with their own style of participation, without them increasing of decreasing their own control. Through converging, the nurses were able to upgrade or downgrade patients' input. From this nurse-patient interactive process, which was dynamic and reciprocal, a theory of patient participation emerged. This was labelled Accommodating Incongruity. Implications for nursing practice, management, theory, education, research, and consumerism are discussed and directions for future research are provided.
18
Teate, Alison Judith. "The experiences of midwives involved with the development and implementation of CenteringPregnancy at two hospitals in Australia /". Electronic version, 2009. http://utsescholarship.lib.uts.edu.au/iresearch/scholarly-works/handle/2100/1005.
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Alexander, Kathy. "Promoting health at the local level : a management and planning model for primary health care services /". Title page, contents and introduction only, 1994. http://web4.library.adelaide.edu.au/theses/09PH/09pha376.pdf.
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20
Baxter, Jennifer Anne, e Jennifer Baxter@aifs gov au. "The Employment of Partnered Mothers in Australia, 1981 to 2001". The Australian National University. Research School of Social Sciences, 2005. http://thesis.anu.edu.au./public/adt-ANU20070716.112159.
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The employment rate of young partnered women and partnered mothers increased considerably over the 1980s, while there was less change in the 1990s. This thesis explores these changes, with a focus on partnered mothers with young children. The objectives are to describe what the changes in female employment were, and to analyse why they might have occurred.
¶
The analyses were primarily quantitative, although they were put into context with extensive reviews of Australian and, where relevant, international literature. The primary source of data was Australian Bureau of Statistics (ABS) Census data. Other data used included those from the ABS Child Care Surveys, Negotiating the Life Course Survey and the National Social Science Survey.
¶
Many changes in maternal employment were identified. The most notable change was the increase in the number and proportion of partnered mothers working part- time hours. Job characteristics also changed, with these women in full-time or part- time jobs more likely to be working in higher skilled professional and para- professional jobs in 2001, compared to 1981. For partnered mothers with a child aged less than one, the proportion working increased, but there was also evidence that more women were making use of maternity leave.
¶
Coinciding with these changes were a number of compositional changes, as women of succeeding birth cohorts were more educated, and more likely to delay marriage and childbearing. Attitudinal change was also evident, as people became more accepting of working wives. Attitudes to working mothers with young children changed less, with a strong preference for mothers to be at home when their children were young. Also over this period, there were many changes in infrastructure, policy and the labour market generally that had impacts on female employment opportunities and conditions. These changes are explored in detail, and their relationship to employment change examined.
¶
Because there were so many changes in these factors occurring over this period, the exact causes of employment change were difficult to identify. Also, an analysis of employment change is complicated because the causality of certain effects does not run in only one direction there are more complex links between education, childbearing and employment that should be accounted for in explaining changes over time. Similarly, changes in supply of labour are difficult to disentangle from changes in demand for labour.
¶
Compositional changes were certainly important in explaining the growth in the proportion working, especially for younger women. These women were not only more highly educated in 2001, they were less likely to have children. For working mothers, the effect of increased education levels could be seen in the greater numbers working in higher status occupations.
¶
The analyses of infrastructure and policy change, particularly that of changes in income support and child care provision which were covered in some detail, did suggest that certain aspects of these broader changes were associated with changes in employment, at least for some sections of the population. Income support changes may have enabled more mothers, particularly those in low-income households, to stay at home with young children. This might be part of the reason for the slower growth in female employment in the 1990s, as payments to single-income families increased.
¶
The increased availability of formal child care was likely to have enabled more mothers to work, although the use of informal care, and parental-care only also grew over the 1980s and 1990s. The cost of care continues to be prohibitive for some families.
¶
Increases in part-time work continued even when the overall rate of employment slowed down. Changes in industrial relations, through award restructuring and the introduction of enterprise bargaining, were associated with an increased availability of part-time jobs. This sustained use of part-time work was congruent with the employment preferences of working mothers with young children. Also, the evidence presented shows that part-time work has grown in higher status as well as lower status jobs.
¶
Overall, while it was not possible to identify the exact causes of employment change, the compositional (education and childbearing changes in particular), attitudinal and broader infrastructure/policy changes were no doubt related.
21
Lymbery, Jennifer Ann Walters. "Giardia and cryptosporidium infection in childcare centres in Western Australia". Murdoch University, 2004. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20070327.94029.
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Giardia and Cryptospovidium are both recognised as important causes of infectious diarrhoea in children worldwide, and childcare centres have been shown to be a major site of infection. The incidence of infectious diarrhoea in children attending childcare centres has been estimated at between two to five times greater than in children cared for at home. Both Giardia and Cryptospovidium have a faecal-oral route of transmission that facilitates their spread in childcare environments, but can also be interrupted through the use of efficient hygiene protocols such as handwashing. Despite their importance as causes of infectious diarrhoea, there are no data on the prevalence or transmission dynamics of these parasites in Australian childcare centres.
The present study was designed to determine the prevalence and incidence of both Giardia and Ciyptosporidium in children attending childcare centres in Perth,Western Australia. Data were collected on asymptomatic infection, seasonal trends, the transmission dynamics of the parasites and risk factors for infection. The second part of the study involved the development, implementation and evaluation of a health intervention package designed to interrupt the transmission of causative organisms of infectious diarrhoea in childcare centres. This intervention was based on appropriate and effective handwashing.
Over a period of 23 months, 1 172 faecal samples were collected from non-toilet-trained children (n=306) attending 14 childcare centres in Perth, Western Australia. Where possible, family and contacts of infected children were also sampled to determine the dynamics of infection in the community. Information on syrnptomology of infections and risk factors for infection was obtained by the administration of a questionnaire to parents of all the children in the study.
Over all the childcare centres in the study, 7.8% of children were positive for Giardia and 10.8% were positive for Cryptosporidiunz. Of these, 37.5% of the Giardia-positive children returned positive samples on two to four occasions, but not always consecutively, suggesting either continuous or repeated infection with the parasite. Only 12% of children who were Cryptosporidiurn-positive were infected for two consecutive months.
The major findings of this study included a significant seasonal peak in the prevalence of both Giardia and Cryptosporidium, with 50% of Giardia and 73% of Cryptosporidiurn infections occurring during the autumn months of March, April and May, and a high proportion of asymptomatic Giardia infections (45%), compared with only 13.5% of asymptomatic Cryptosporidiurn infections.
There was evidence for the transmission of both Giardia and Cryptosporidium infections to household contacts of infected children. Of the children who were found to be positive, faecal samples were also collected from 28 family members of those children with Giardia and from 14 family members of those with Cryptosporidiunz. Of these, 17.9% family members of the children with Giardia and 28.6% of family members of the Cryptosporidiuin children returned positive faecal samples. The only significant risk factor for Giardia infection was the number of adults living in the household, with infection more likely to occur in children who had a greater number of adults in the household. Significant risk factors for Clyptosporidium infection included the age of the child: the mean age of the positive children (20.6 months) was higher than in the negative children (16.6 months), and the length of time enrolled at the centre. Children who were positive had attended for a longer time than those who were negative (1 1.2 and 7.8 months respectively).
These results have important implications for the control of infection with these organisms, both within and beyond childcare centres. Since these parasites can be readily transmitted by an asymptomatic carrier, the high percentage of asymptomatic cases in this study, particularly of Giardia, strengthens the argument for health interventions which are directed at interrupting the trailsmission of the parasite.
A health intervention programme was developed that focused on handwashing procedures and was targeted at the carers, the children and the parents of the children in the centres. It was designed to be a low-cost programme both financially, and in the time and effort required to implement the programme within the childcare centre, to enhance compliance with the intervention. The success of the programme in changing the knowledge, attitudes and practices of carers was evaluated through a pre- and posttest questionnaire. This showed that the programme successfully improved the knowledge of the carers in the test centres in several important areas of infection control. These included knowledge about specific organisms causing infectious diarrhoea in childcare centres, transmission of these by asymptomatic individuals and increased knowledge about effective handwashing technique. Because it has been repeatedly shown that increased knowledge does not always translate into improved practices, and that interventions are not always successful in maintaining an improvement in the desired practices, a subjective evaluation was also performed. This was designed to determine how effective the intervention was perceived to be by the carers themselves, and whether they would continue to use the intervention over time. The results showed that the majority of the carers (>88%) found the intervention appropriate and useful in teaching both the carers and the children within the centres, the importance of handwashing. Twelve months after the intervention had first been implemented, 57% of the centres in the study were still using the intervention at least once per month and a further 2996, while using it less than this, still continued to use it occasionally. This is important information, since an intervention can only be useful if it is actually being used.
22
Chalmers, Jane. "The oral health of older adults with dementia". Title page, contents and abstract only, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phc438.pdf.
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Bibliography: leaves 347-361. Presents results of 2 longitudinal studies investigating the oral health of older adults with dementia, using questionnaires and clinical inspections at baseline and one year. Groups studied were nursing home residents and those living in the community, with moderate to severe dementia or no dementia diagnosis. Caries experience was related to dementias severity and not to specific dementia diagnoses. Coronal and root caries experience was higher in dementia participants with moderate-severe dementia, the socio-economically disadvantaged, more functionally dependent, taking neuroleptic medications with high anticholinergic adverse effects, with eating and swallowing problems, were not attending the dentist, who needed assistance and were behaviourally difficult during oral hygiene care and whose carers were burdened.
23
Walker, Annette Clare, of Western Sydney Nepean University e Faculty of Nursing and Health Studies. "Nurse and patient work: comfort and the medical-surgical patient". THESIS_FNHS_XXX_Walker_ A.xml, 1996. http://handle.uws.edu.au:8081/1959.7/286.
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This grounded theory study investigates the experiences and perceptions of comfort and discomfort of hospital patients admitted for medical-surgical conditions, with a focus on the post-accute stage of hospitalisation. In-depth post-discharge interviews were conducted with seventeen English speaking adults who had been admitted to nine Australian hospitals. A substantive theory of finding comfort and of managing discomfort was generated. Processes of self-talk (anticipating, interpreting, accepting, making allowances and maintaining perspective) and self-care (self-help and seeking help, which involved accommodating to the level and type of help available through deferring, avoiding, persisting or desisting) were used to find comfort and to manage discomfort. The study has implications for nursign practice, management, research and education. Existing practice in the areas of assessment, communication, individualised care planning and the management of discomfort need to be strengthened if nursing care is to make a difference for this category of patient. The study revealed that integrated caring by nurses perceived by informants as 'experts', contributed most to the experience of finding comfort and managing discomfort in this group of informantsDoctor of Philosophy (PhD)
24
Forsyth, Rowena Public Health & Community Medicine Faculty of Medicine UNSW. "Tricky technology, troubled tribes: a video ethnographic study of the impact of information technology on health care professionals??? practices and relationships". Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/30175.
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Whilst technology use has always been a part of the practice of health care delivery, more recently, information technology has been applied to aspects of clinical work concerned with documentation. This thesis presents an analysis of the ways that two professional groups, one clinical and one ancillary, at a single hospital cooperatively engage in a work practice that has recently been computerised. It investigates the way that a clinical group???s approach to and actual use of the system creates problems for the ancillary group. It understands these problems to arise from the contrasting ways that the groups position their use of documentation technology in their local definitions of professional status. The data on which analysis of these practices is based includes 16 hours of video recordings of the work practices of the two groups as they engage with the technology in their local work settings as well as video recordings of a reflexive viewing session conducted with participants from the ancillary group. Also included in the analysis are observational field notes, interviews and documentary analysis. The analysis aimed to produce a set of themes grounded in the specifics of the data, and drew on TLSTranscription?? software for the management and classification of video data. This thesis seeks to contribute to three research fields: health informatics, sociology of professions and social science research methodology. In terms of health informatics, this thesis argues for the necessity for health care information technology design to understand and incorporate the work practices of all professional groups who will be involved in using the technology system or whose work will be affected by its introduction. In terms of the sociology of professions, this thesis finds doctors and scientists to belong to two distinct occupational communities that each utilise documentation technology to different extents in their displays of professional competence. Thirdly, in terms of social science research methodology, this thesis speculates about the possibility for viewing the engagement of the groups with the research process as indicative of their reactions to future sources of outside perturbance to their work.
25
Stocks, Nigel. "Trachoma and visual impairment in the Anangu Pitjantjatjara of South Australia /". Title page, contents and abstract only, 1992. http://web4.library.adelaide.edu.au/theses/09MD/09mds865.pdf.
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26
Carter, Robert C. (Robert Charles) 1950. "The macro economic evaluation model (MEEM) : an approach to priority setting in the health sector". Monash University, Dept. of Management, 2001. http://arrow.monash.edu.au/hdl/1959.1/8672.
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27
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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28
Loh, Poh Kooi. "Innovations in health for older people in Western Australia". University of Western Australia. School of Medicine and Pharmacology, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0051.
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Australia and many other developed communities are ageing rapidly, placing a strain on the delivery of health services. This thesis examines the use of innovative health services management coupled with information and communication technology (ICT) to more efficiently deliver services to disabled older people in the hospital, community and residential care. The hypothesis explored is that ICT can provide clinical services to older people in poorly serviced communities and groups, thus extending the influence and capabilities of specialist health care professionals. The relevance of these studies is predominantly for those people who live outside the metropolitan regions, particularly in remote and rural communities, and also for those frail older people, who because of disability, are unable to travel to specialist health services. There are a series of studies presented in this thesis which have all been published. They have demonstrated that in a community and rural setting, ICT use in the assessment and management of geriatric syndromes such as dementia is valid and practical. This included the validation of commonly used assessment tools via Telehealth. A Telehealth protocol for assessment of Alzheimer's Dementia (AD) was developed and published. The use of ICT to link health services clinical and administrative data for determining stroke outcomes and disability has been evaluated and a resource utilization prediction model developed. Finally, in residential care a survey and a qualitative study of poor uptake of ICT services in hostels and nursing homes revealed insights into ICT perception by the older people in care facilities and their professional staff. The implications and future development of these studies have been discussed, especially barriers to increased uptake of ICT, cost comparisons and the potential of future technologies such as video conferencing mobile phones.
29
MacGill, Bindi Mary, e belinda macgill@flinders edu au. "ABORIGINAL EDUCATION WORKERS IN SOUTH AUSTRALIA: TOWARDS EQUALITY OF RECOGNITION OF INDIGENOUS ETHICS OF CARE PRACTICES". Flinders University. School of Australian Studies, 2009. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20090630.142151.
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This thesis is focused on Aboriginal Education Workers (AEWs) who work with, support and care for Indigenous students in schools in South Australia. AEWs work in the border zones (Giroux 2005) between the values of schools and the expectations of Indigenous communities. This thesis highlights how AEWs experience indirect discrimination in the workplace as a result of their complex racialised position. In particular, there is a general absence of recognition of AEWs caring role by non-Indigenous staff in schools.
AEWs are not only marginalised in schools, but also at an institutional level. While AEWs working conditions have improved, the redistribution (Fraser & Honneth 2003, p. 10) of better working conditions has not eliminated indirect discrimination in the workplace. Furthermore, there is little research regarding AEWs in Indigenous education. Thus at three levels, namely school, Department of Education and Childrens Services (DECS) and academia, there is a cyclical pattern that perpetuates an absence of recognition of AEWs.
This thesis uses whiteness theory (Frankenberg 1993) as a theoretical framework to examine this lack of recognition and the consequent low status of AEWs in schools. The thesis emerges from research, experience working as a teacher in a remote Aboriginal school with AEWs, and in-depth semi-structured interviews with 12 AEWs who are working in South Australian state schools. Standpoint theory (Collins 2004; Harding 2004) is used as both a method and methodology in order to understand and map AEWs position in schools. A common theme raised by all of the AEWs in the interviews is the absence of recognition of their work in schools by non-Indigenous staff and the consequent feeling of marginalisation in the workplace. In this thesis the site-specific contexts of the interviewees and the effects of whiteness are examined.
The findings that emerged from the in-depth semi-structured interviews with AEWs were concerned with Indigenous ethics of care models. The narratives from the interviewees who were AEWs revealed how white ethics of care practices in schools de-legitimise Indigenous ethics of care. Furthermore, the discursive regimes that govern school policy and protocol often limit AEWs ability to respond effectively to Indigenous student needs. This thesis highlights the complexities and contradictions of AEWs who are working in the border zones. As a result, AEWs often feel caught between school expectations and community protocols.
This thesis advocates equality of recognition of Indigenous ethics of care practices to address the indirect discrimination that AEWs experience. It concludes with a map for recognition of AEWs' care practices on an institutional level in relation to academia and DECS, and in schools in order to overturn the continual marginalisation of AEWs in South Australia. It argues for a values shift for non-Indigenous teachers and staff in schools and at the institutional levels in DECS and academia. In particular, this involves a values shift by non-Indigenous teachers, academics and policy makers towards an understanding of whiteness. Recommendations are provided in the concluding chapter that signpost possible moves towards equality of recognition of Indigenous ethics of care practices by non-Indigenous staff in schools.
30
Donato, Ron. "The economics of health care finance and reform : implications of market-based health reform in Australia /". Title page, table of contents and abstract only, 1996. http://web4.library.adelaide.edu.au/theses/09ECM/09ecmd677.pdf.
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31
au, A. Eades@murdoch edu, e Anne-Marie Eades. "Factors that influence participation in self-management of wound care in three Indigenous communities in Western Australia: Clients' perspectives". Murdoch University, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20090702.111437.
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The purpose of this study was to identify any barriers or enablers as influences on wound care self-management by Indigenous people. A qualitative, interpretive study sought to investigate how participants perceived their wounds and their general health, and to identify the influences on them accessing wound care services.
There is a dearth of information on culturally appropriate practice in wound management for Indigenous Australians. This research project was therefore significant in attempting to bridge the gap in nursing knowledge of Indigenous clients' perceptions of barriers and enablers for seeking wound care services,especially in relation to lower leg ulcers. The lack of culturally sensitive wound management practices potentially impacts on Indigenous clients' behaviours in seeking treatment from their health service providers.
Participant observations and semi-structured interviews with the research participants investigated the management of their wounds, and the ways in which their culture influences wound management. The main aim was to understand participants' comprehension of the importance of wound care through reflection. Understanding the enhancing or obstructive influences on wound management practices was expected to provide a foundation for teaching self care of wounds in Indigenous populations and inform health professionals' approach to health education.
The data were analysed using thematic analysis, which generated common themes related to the research questions. These themes are: visibility, of the problem,4 perceived versus actual level of knowledge, acceptance of co-morbid health conditions and pre-determined path of ill health. These findings indicated that in one region, participants' perception of poor health was related to visibility of the problem. Participants chose to have their visible wounds managed by Silver Chain Nursing Association, whereas Diabetes and Hypertension and any other non-visible disorders were seen as appropriate to the Aboriginal Medical Service (AMS). Further to this finding, most participants displayed a sense of helplessness and hopelessness when sharing information about their diagnosis of diabetes, believing this was the norm. Many also believed that having a strong family history of a particular disease resulted in the participants also inheriting the disease. During post interview educational sessions many of the Indigenous participants were surprised by the evidence based-research reported to them by the researcher that diabetes is a manageable disease with life style changes.
Another issue highlighted was the perceived level of knowledge the participants had about wound care. Reassurance was given by the participants that their level of knowledge about how to manage their wounds was adequate. However, none of the participants were concerned about the length of time that their wound/s had or were being managed, between 3 months and 5 years. This acceptance that although a wound is not getting any worse and not getting any better was the norm is cause for concern, and indicates a low level of health literacy. This theme was 'perceiving an imbalance in perceptions of wound care knowledge with actual knowledge'.
The most important recommendation from the study findings is the need to consider health literacy more carefully in the development of health promotion and health education for Indigenous clients with wounds.
32
Ruler, Amanda Jane. "Culture of nursing homes : an ethnomethodological study /". Title page, contents and abstract only, 2000. http://web4.library.adelaide.edu.au/theses/09PH/09phr935.pdf.
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O'Connell, Beverly O. "A grounded theory study of the clinical use of the nursing process within selected hospital settings". Curtin University of Technology, School of Nursing, 1997. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=11092.
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The nursing process is the espoused problem solving framework that forms the basis of the way in which patient care is determined, delivered, and communicated in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards the use of the nursing process. They claim that both the structure and language that underpins this process is cumbersome and unreflective of the way in which nursing care is planned and delivered. To date, there has been no study cited that has examined its use within a clinical setting and determined if and how the nursing process is being used and whether there is substance in the clinicians' claims. Additionally, some of the research on problem solving has used laboratory based designs that are limited as they are not sensitive to contextual factors that affect the use of a problem solving process, nor are they sensitive to the efficacy of the communication process. As patient care involves many nurses working under diverse contextual conditions, these factors need to be taken into consideration when studying this phenomenon.Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Specifically, it sought to answer the following two questions: (1) How is the nursing process used by nurse clinicians in acute care hospital settings? and in the absence of its use, (2) How is nursing care determined, delivered, and communicated in acute care hospital settings in Western Australia?Data were obtained from semi-structured interviews with predominantly nurse clinicians, patients, and patients' relatives, as well as participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant ++comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. This resulted in the generation of a substantive theory explaining clinical nursing in acute care hospital settings.The findings of this study revealed several problems with the clinical application of the nursing process. It also revealed a process used by nurses to overcome many difficulties they experienced as they tried to determine, deliver, and communicate patient care. Specifically, nurses in this study experienced the basic social problem of being in a state of "Unknowing". Properties and dimensions of unknowing were found consistently in the data and this problem was labelled as the core category. This state of "unknowing" was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. In order to deal with this problem, the nurses in this study used a basic social process termed: "Enabling Care: Working through obscurity and uncertainty". The first phase of the core process, termed: Putting the pieces together: making sense, involved four subprocesses. These subprocesses were labelled: drawing on the known, collecting and combining information, checking and integrating information, and sustaining communication. The second phase of the core process was termed Minimising uncertainty. It involved three subprocesses which were named: adapting work practices, taking control, and backing-up.The findings of this study have implications for nursing practice, research, theory, and education, as it exposes problems with the clinical application of the nursing process in acute care settings. In addition, it further explicates a substantive theory that describes a ++
process of nursing used by nurses in these settings. As the articulated process was supported by a number of studies and opinions of nurse scholars it is worthy of being considered as being foundational to an understanding of a process of nursing used in acute care hospital settings in Western Australia.
34
Andersson, Sandra. "Bedömningen av "lämpliga" familjehem i Sverige och Australien. : En jämförande studie". Thesis, Linnéuniversitetet, Institutionen för socialt arbete (SA), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-56466.
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This study is about the assessment of foster care families and what´s considered a suitable foster care home. It is a comparative study between two welfare countries, Sweden and Australia. The study aims to increase the understanding of social workers assessment on foster care families and examines what a suitable foster care home looks like for a few social workers in each country. The study was carried out through five qualitative interviews, three of them in Sweden and two of them in Australia. With a social constructivist theory the result was carried out and analysed. The result of the study shows differences in the way social workers in each country talk about the suitability of a foster carer. In Australia the social workers that participated in the study spoke about a suitable foster family as a family that is safe and can provide a safe environment. In Sweden the social workers spoke about a suitable family as a secure and stable family. The result of the study also shows similarities between the two countries, as an example the nuclear family is still the norm and other family structures are exceptions of the norm.
35
Balnave, Nikola Robyn. "Industrial Welfarism in Australia 1890-1965". University of Sydney. Work and Organisational Studies, 2002. http://hdl.handle.net/2123/572.
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This thesis examines industrial welfarism in Australia from 1890 to 1965. This period witnessed the gradual spread of the welfarism movement throughout Australian industry as employers sought ways to increase productivity and control in the face of external challenges. Once reaching its peak in the immediate post-War period, the welfarism movement was gradually subsumed as part of the increasing formalisation of personnel management. Waves of interest in welfare provision coincided with periods of labour shortage and/or labour militancy in Australia, indicating its dual role in the management of labour. Firstly, by offering benefits and services beyond that made necessary by the law or industrial awards, welfarism was designed to create a pool of good quality workers for management to draw from. Secondly, managers sought to enhance their control over these workers and their productive effort, using welfarism as a technique to build worker consent to managerial authority. This could be achieved through subtle methods aimed at boosting loyalty and morale, or through more direct programs designed to increase worker dependency on the company. In both ways, individual and collective worker resistance could be minimised, thereby reinforcing managerial prerogative. Despite its adoption by a variety of companies, a number of economic, political and institutional factors limited the extent of industrial welfarism in Australia. These include the small-scale of most enterprises prior to the Second World War, state involvement in the area of industrial relations and welfare provision, and the strength of organised labour. While the welfarism movement did not reach the heights experienced overseas, it nonetheless provided an important contribution to the development of formal labour management in Australia.
36
Hawley, Georgina. "A phenomenological study of the health-care related spiritual needs of multicultural Western Australians". Curtin University of Technology, Science and Mathematics Education Centre, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=13369.
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This study was designed to identify the spiritual needs of multicultural Australians with a health problem, in order to understand the educational implications for health care professionals. The rationale for the research was supported by the Australian Council for Health Service (1997) requirement that health care professionals meet the spiritual needs of their patients and clients'. At the commencement of this study, no research had been published on what these spiritual needs might be. To discover what health care professionals needed to be taught in order to meet the spiritual needs of their patients, I required a suitable group of patients. Then, after identify their spiritual needs, I wanted to explore ways in which these needs could be met. For this to occur, I also needed to identify factors that would fulfill patients' spiritual needs or prevent them from being met. This research proceeded in two stages. The first involved collecting data from all spiritual groups in Western Australia. The second involved the recruitment and interviewing a small number of ex-patients to gain their perspective of health care related spirituality and needs. To gain data about the various spiritual groups in Western Australia, I wrote to all organisations and associations, asking for information and reference material. This data was analysed using HyperResearch (1995), and themes common to all spiritual groups were developed. The inter-relationship between these themes provided the framework for an emergent model of spirituality.For the second part of the research which involved a case study of health care patients, a qualitative methodology was used. This approach enabled me to explore the phenomenon of spirituality from the perspective of eight participants, which involved identifying their spiritual needs, the care they desired, and the rite of passage they underwent when receiving health care. The qualitative methodology enabled me to explore the subject from a sensitive holistic perspective, and to protect the integrity of the participants. I wanted to know what patients understood about their spirituality and how spiritual care could be implemented not only in clinical practice but also into health care education programs. The participants' detailed subjective experience was especially important, because I wanted to know how they identified their spiritual needs, how they had requested their needs be met by health care professionals, and the extent to which health care professionals had reacted to those cues. I formulated an 'interpretive phenomenology research' design based on the philosophical writings of Heidegger and Bakhtin. Heidegger argued that people gain knowledge of a subject from their own subjective experience, and of the person being in their world (simultaneous past, present and future thoughts). Bakhtin stated that to bring about social change, the researcher needed to understand the social context of the people's language including their culture, politics, government-provided amenities (such as education and health care), employment and social interaction, both within and outside their communities in which they live. The eight participants were interviewed a number of times in order to explore the phenomenon of spirituality beyond the notions already published in the literature (i.e. from multicultural Australian's perspective).
They told of hospital or health care experiences that included: health care for childbirth, mental and psychiatric illnesses (depression, manic-depression, and anxiety), immunology (lymphoma), stroke, detoxification of alcohol, arthritis, coronary occlusion, hypertension, and peritonitis; surgical procedured/s such as repair of hernia, bowel obstruction, eye surgery, orchiopexy (removal of testes from inguinal canal into the scrotal sac), caesarian birth, appendectomy, and oophorectomy (removal of ovaries); treatments such as radiotherapy, chemotherapy, and physiotherapy; and hospital experiences in both large and small public and private acute hospitals, private and public mental health/psychiatric hospitals, intensive care and coronary care units. These situations demonstrate the diversity of contexts which people want their spiritual needs met. The study revealed that it is not only dying patients who have spiritual need; spiritual needs exist in widespread ordinary conditions and across a wide range of health care services. The eight participants - Ann, Athika, Garry, Red, Rosie, Scarlet, Sophie, and Tom (pseudonyms) - were drawn from many of the multicultural groups resident in Western Australia including Aboriginal, Chinese, English, European, Indian, and Irish peoples. Their spiritualities encompassed Judeo-Christian, Buddhist, Hindu, Pagan Romany, Society of Friends (Quaker), Humanist, Socialist, and Communist values and beliefs. The results of the research give insight into the eight participants' perspectives on being a person, their understanding of spirituality, perceived spiritual needs, their desired levels of spiritual care, and the rite of passage they experienced when undergoing health care treatment in hospital.
The participants' spiritual needs comprised of four categories: 'mutual trust', 'hope', 'peace' and 'love'. The levels of spiritual care spoke of desiring were: 'acknowledgement', 'empathy', and 'valuing'. Recommendations are given for health care professionals to provide spiritual care for the eight participants, and implications are considered for the spiritual education of future health care professionals in order to sensitise them to the wide range of healthcare related spiritual needs they might encounter in local multicultural communities. It is recognised that the scope of the implications is contingent on further research establishing the incidence of health-care related spiritual needs among the broader population of multi-cultural Western Australians. The richness and depth of the data and the very sensitive nature of the material that came from the eight people who shared their experiences with me has rendered this thesis an important document. The nature of the various incidents and situations they shared with me, I believe, demonstrated their preparedness to tell their story so that health care can be improved. On many occasions, I felt honoured that they had sufficient trust in me to enable them to report such deep and personal suffering. For example, Rosie told me of her mental torment and of not knowing if she was alive or dead; of how she burnt her legs to try to feel pain in order to see if she was alive. It was stories such as this that gave me the passion to write this thesis well in order to do justice to all people who want spirituality included in health care treatment.
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Murphy, Mary Denise. "Living with asthma in Australia : an anthropological perspective on life with a chronic illness". University of Western Australia. School of Anatomy and Human Biology, 2005. http://theses.library.uwa.edu.au/adt-WU2005.0070.
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[Truncated abstract] In Australia, asthma is a common chronic illness, which often requires complex treatment regimens. This study used an anthropological perspective to explore the experience of people living with asthma, with the specific aim of contributing to the health care programs offered to people living with asthma. The study was conducted in an Australian city (Perth, Western Australia). The foci of the study were Australian lay people, from the general community, living with asthma, and a small number of non- English speaking Vietnamese-Australian migrants. Some spouses of the Australians and biomedical practitioners were also included. Questionnaires, and particularly indepth interviews, were used to explore the explanatory models of asthma for doctors and lay people with the condition. The explanatory models of the doctors focused primarily on assessing and treating the physiological dimension of asthma, and educating patients. The explanatory models for lay people with asthma reflected their everyday reality: in addition to its impact on their physical health, asthma affected their daily life, social roles and participation, and their personal identity. Placing the experience of asthma in this wider perspective showed that the Australians used practical reasoning to make a trade-off between using medication, such that they felt safe from `attacks? and could `do all they wanted to do?, and minimising their `dependence? on potentially harmful medications. Responding to acute episodes involved a risk assessment in which people weighing the health risk of waiting against the social risk of seeking help unnecessarily. For the Vietnamese- Australians, caring for asthma was strongly shaped by their social position as non- English speaking migrants. They lacked access to information about asthma and to specialist care. They had sufficient medication, but were ill-informed about how to use their medicines effectively and safely: in general, the Vietnamese people were overmedicated but under-serviced in the care of their asthma. Beyond explanatory models, the Australian participants (lay people and doctors) shared a cultural model of asthma as a chronic illness. This Australian cultural model shaped the experience and care of asthma. It included concepts such as framing the past as an adjustment process, and the present as `living normally? with asthma. Taking care of asthma was expressed as `taking control? of asthma, so a person could minimise the illness and still be healthy. The Vietnamese-Australians did not share this cultural model of asthma as a chronic illness, as reflected in their expression of the hardship asthma created in limiting their ability to work hard for their family, and how they expected a cure for their condition from biomedicine. The Australians also shared a cultural model of health that was derived, in part, from the health promotion messages that are targeted at lay people. These promotional messages were the basis of a morality in health: people shared an implicit understanding that a person deserved health, and assistance when ill, when he/she displayed the required self-discipline in performing health behaviours.
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Irvine, Susan. "Parent Conceptions of Their Role in Early Childhood Education and Care: A Phenomenographic Study from Queensland, Australia". Queensland University of Technology, 2005. http://eprints.qut.edu.au/16165/.
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Over past decades, the face of Australian early childhood education and care (ECEC)has changed substantially. It has been shaped by two dominant policy discourses: the discourse of market theory, and, more recently, the discourse of parent and community participation. The intertwining of these two seemingly opposing discourses has led to the positioning of parents both as consumers of ECEC and as participants in ECEC. Each of these perspectives promotes a particular way of fulfilling the role of parent in ECEC. Reflecting general marketing principles, the primary role of parent as consumer is seen as selecting the right service for their child and family. In contrast, while arguably more ambiguous in meaning, the role of parent as participant promotes a partnership approach, and, increasingly, parental involvement in decision making at both service and public policy levels. Each of these roles has been constructed for parents by governments and policymakers, with little reference to the views and experiences of parents using ECEC. Seeking to address this gap in the ECEC knowledge base, the present study investigated the qualitatively different ways in which parents constitute their role in Australian ECEC. The study focused on two related aspects of the role of parents: (1) the role of parents in using ECEC services; and (2) the role of parents in shaping ECEC public policy. To describe these roles, as viewed and experienced by parents, and to reveal possible variation therein, the study engaged a phenomenographic research approach (Bowden & Walsh, 2000; Marton & Booth, 1997). Twenty-six parents participated in the study. Data were gathered through semistructured interviews with individual parents and subjected to a rigorous process of phenomenographic analysis. The study results are presented in two parts. With respect to the role of parents using ECEC, the study led to the construction of five categories of description, denoting five distinctly different ways of seeing and experiencing this role. The role of parents was seen as: (1) selecting and using the best service for their child (the service user conception); (2) knowing what's happening for their child in the service (the informed user conception); (3) paying for a service, and, thereby, enacting certain consumer rights (the consumer conception); (4) supporting their selected service and having some say in what happens for their child at the service (the partnership conception); and (5) working as a member of the service community for the benefit of all concerned, which includes participating in decision making (the member of a service community conception). Taking a broader perspective, the study again revealed variation in how parents constituted their role in shaping ECEC policy, leading to the construction of four categories of description. The role of parents was seen as: (1) no role in shaping ECEC public policy (the no role conception); (2) being informed about policy that affects their child and family, raising any concerns and/or seeking a change to current or proposed policy (the raising concerns conception); (3) having some say in policy matters that affect their child and family (the having some say conception); and (4) participating in policy decision making, particularly where this is likely to affect their child and family (the participating in policy decision making conception). The study highlights variation in how these roles are constituted by parents, inclusive of the basic concepts of parent as consumer and parent as participant. In addition, the study offers an insider perspective on these two "dominant common-sense understandings" (Vincent & Martin, 2000, p. 2) of the role of parents, prompting questions about their future in ECEC policy. As an example of "developmental phenomenography" (Bowden, 2000b, p. 3), the study also identifies factors perceived by parents as influencing their participation at various levels, and discusses implications for both policy and practice. Finally, the study extends the general phenomenographic area of interest, from education to public policy research. Within this area, phenomenography is seen to offer a useful and pragmatic research tool, facilitating the identification and consideration of different constituent views and experiences, and, thereby, signifying more possible options for action.
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Descoteaux, Jill. "Dancers’ Reflections on Their Healthcare Experiences: Perspectives from Australia and the USA". Ohio University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1530538560639848.
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Leon, de la Barra Sophia. "Building research capacity for indigenous health : a case study of the National Health and Medical Research Council : the evolution and impact of policy and capacity building strategies for indigenous health research over a decade from 1996 to 2006". University of Sydney, 2007. http://hdl.handle.net/2123/3538.
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Master of PhilosophyAs Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.
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Sorensen, Ros Public Health & Community Medicine Faculty of Medicine UNSW. "The dilemma of health reform : managing the limits of policymaking, managerialism and professionalism in health care reform". Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2002. http://handle.unsw.edu.au/1959.4/33194.
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Hospitals worldwide are under pressure to perform and models abound to remedy poor performance. Reform, however, is contested, uneven and slow. One reason is that few models address a core issue in reform: the management of clinical work. A further reason is that stakeholder groups, specifically policymakers, managers and clinicians, limit opportunities for collaborative problem solving as they seek to impose their own frame of reference in the struggle for control. I hypothesise that performance will be relatively better in hospitals that have in place strategies of agreement to set the objectives of reform, such as participative problem identification, problem solving and decision making, together with a method to manage clinical work. This hypothesis was tested in twelve public hospitals in three Australian states between 1999 and 2001 using both quantitative and qualitative research methods. Government and hospital policy documents were assessed and semi-structured interviews were conducted to gauge the attitudes and practices of managers and clinicians regarding health care reform. The results of the research show that hospitals with inclusive strategies for change, principally strategies of agreement, joint education and skills development, team-based incentives to direct and reward effort and a method of clinical work management, performed better than those without. Findings indicate that policy was developed and communicated as a rational top-down process that tended to exclude diverse views. Although the effect of different jurisdictional policy processes on hospital performance was not clear, they had considerable impact on the environment of reform. Cost containment and patient safety dominated as policy objectives. These alone did not engage clinician interest or address service quality. The connection between the quality of care and its cost did not appear to be understood. Organisational structures and processes necessary to support reform, that is communication forums for objective setting and performance review, integrated clinical and corporate accountability systems and organisational capacity building were not in place in the majority of hospitals studied. An organisational model of clinical work management was developed to improve cost-effectiveness by balancing clinical autonomy and clinical accountability based on the research results.
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Eades, Anne. "Factors that influence participation in self-management of wound care in three indigenous communities in Western Australia : clients' perspectives /". Murdoch University Digital Theses Program, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20090702.111437.
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Orr, Neil John. "Patterns of care for diabetes: risk factors for vision-threatening retinopathy". University of Sydney, 2005. http://hdl.handle.net/2123/1421.
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Master of Public HealthOBJECTIVES: In Australia, diabetes causes significant morbidity and mortality. Whilst the need to prevent diabetes and its complications has been widely recognised, the capacity of health care systems - which organise diabetes care - to facilitate prevention has not been fully established. METHODS: A series of seven population-based case-control studies were used to examine the effectiveness of the Australian health care system and its capacity to manage diabetes. Six of the studies compared the patterns of care of patients who had developed advanced diabetes complications in 2000 (cases), to similar patients who remained free of the condition (controls) across Australia and for various risk groups. A secondary study investigated the role of treating GPs in the development of the outcome. RESULTS: A strong relationship between the patterns of care and the development of advanced diabetes complications was found and is described in Chapter 4. In Chapter 5, this same relationship was investigated for each Australian state and territory, and similar findings were made. The study in Chapter 6 investigated whether late diagnosis or the patterns of care was the stronger risk factor for advanced diabetes complications, finding that the greatest risk was associated with the latter. In Chapter 7 the influence of medical care during the pre-diagnosis period was explored, and a strong relationship between care obtained in this period and the development of advanced complications was found. In Chapter 8, which investigated the role of socio-economic status in the development of advanced complications, found that the risk of advanced diabetes complications was higher in low socio-economic groups. Chapter 9 investigated geographic isolation and the development of advanced diabetes complications and found that the risk of advanced complications was higher in geographically isolated populations. Finally, Chapter 10, which utilised a provider database, found that some GP characteristics were associated with the development of advanced diabetes complications in patients. CONCLUSION: A number of major risk factors for the development of advanced complications in Australia was found. These related to poorer diabetes management, later diagnosis, low socioeconomic status and geographic isolation. Strategies must be devised to promote effective diabetes management and the early diagnosis of diabetes across the Australian population.
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Trigg, Lisa. "Improving the quality of residential care for older people : a study of government approaches in England and Australia". Thesis, London School of Economics and Political Science (University of London), 2018. http://etheses.lse.ac.uk/3772/.
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Improving the quality of residential care for older people is a priority for many governments, but the relationship between government actions and high-quality provision is unclear. This qualitative research study uses the cases of England and Australia to examine and compare regulatory regimes for raising provider quality. It examines how understandings of quality in each country are linked to differences in the respective regulatory regimes; how and why these regimes have developed; how information on quality is used by each government to influence quality improvement; and how regulatory regimes influence providers to deliver quality. The study develops a new typology of three provider quality orientations (organisation-focused, consumer-directed, relationship-centred) to examine differences between the two regulatory regimes. The research draws on interviews conducted between January 2015 and April 2017 with 79 individuals from different stakeholder groups in England and Australia, and interviews with 24 individuals from five provider organisations in each country. These interviews highlighted greater differences between the two regimes than previous research suggests. For example, while each system includes a government role for inspecting or reviewing provider quality, there are differences around how quality is formally defined, the role and transparency of quality information, and how some provider quality behaviour is influenced by different policy interventions. Two important findings emerge from the study for policymakers and researchers. First, the importance of considering the broader historical and institutional context of the care sector overall, not simply the regulatory environment, as shown by the more welfare-oriented approach in England when compared to Australia’s highly consumerist approach. Second, the importance of considering the overall ‘regulatory space’ when designing policy interventions for quality. Policymakers should consider the effects and interaction of multiple policy interventions, the impact of funding mechanisms and the activity of multiple stakeholders, and not restrict attention to those policy interventions explicitly developed for quality improvement goals.
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Ho, Kwok Ming. "Use of prognostic scoring systems to predict outcomes of critically ill patients". University of Western Australia. School of Medicine and Pharmacology, 2008. http://theses.library.uwa.edu.au/adt-WU2009.0101.
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[Tuncated abstract] This research thesis consists of five sections. Section one provides the background information (chapter 1) and a description of characteristics of the cohort and the methods of analysis (chapter 2). The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system is one of commonly used severity of illness scoring systems in many intensive care units (ICUs). Section two of this thesis includes an assessment of the performance of the APACHE II scoring system in an Australian context. First, the performance of the APACHE II scoring system in predicting hospital mortality of critically ill patients in an ICU of a tertiary university teaching hospital in Western Australia was assessed (Chapter 3). Second, a simple modification of the traditional APACHE II scoring system, the 'admission APACHE II scoring system', generated by replacing the worst first 24-hour data by the ICU admission physiological and laboratory data was assessed (Chapter 3). Indigenous and Aboriginal Australians constitute a significant proportion of the population in Western Australia (3.2%) and have marked social disadvantage when compared to other Australians. The difference in the pattern of critical illness between indigenous and non-indigenous Australians and also whether the performance of the APACHE II scoring system was comparable between these two groups of critically ill patients in Western Australia was assessed (Chapter 4). Both discrimination and calibration are important indicators of the performance of a prognostic scoring system. ... The use of the APACHE II scoring system in patients readmitted to ICU during the same hospitalisation was evaluated and also whether incorporating events prior to the ICU readmission to the APACHE II scoring system would improve its ability to predict hospital mortality of ICU readmission was assessed in chapter 10. Whilst there have been a number of studies investigating predictors of post-ICU in-hospital mortality none have investigated whether unresolved or latent inflammation and sepsis may be an important predictor. Section four examines the role of inflammatory markers measured at ICU discharge on predicting ICU re- 4 admission (Chapter 11) and in-hospital mortality during the same hospitalisation (Chapter 12) and whether some of these inflammatory markers were more important than organ failure score and the APACHE II scoring system in predicting these outcomes. Section five describes the development of a new prognostic scoring system that can estimate median survival time and long term survival probabilities for critically ill patients (Chapter 13). An assessment of the effects of other factors such as socioeconomic status and Aboriginality on the long term survival of critically ill patients in an Australian ICU was assessed (Chapter 14). Section six provides the conclusions. Chapter 15 includes a summary and discussion of the findings of this thesis and outlines possible future directions for further research in this important aspect of intensive care medicine.
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De, Voe Jennifer. "New national approaches to community health : a comparative analysis of historical case studies from Australia and the United States". Thesis, University of Oxford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367771.
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Blaxland, Megan. "Everyday negotiations for care and autonomy in the world of welfare-to-work: The policy experience of Australian mothers, 2003-2006". University of Sydney, 2009. http://hdl.handle.net/2123/4134.
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Doctor of Philosophy (PhD)A significant new direction in Australian income support policy was introduced in 2002. Known as Australians Working Together, this development changed the basis of social security entitlement for parents. Throughout most of the twentieth century, low-income sole mothers, and later sole fathers and parents in couple families, could claim income support throughout most of their children’s school years. The primary grounds for their entitlement were low income and parenting responsibilities. Australians Working Together introduced compulsory employment-oriented activities to Parenting Payment entitlement for parents whose youngest child had turned 13. This thesis investigates mothers’ experience of this new welfare system. Using Dorothy Smith’s ‘everyday life’ approach to research, it draws upon qualitative and quantitative methods to analyse Australians Working Together. The research is grounded in a longitudinal interview survey of Australian mothers of teenage children who were subject to these changes. The analysis moves from their experience outwards through the four levels of analysis in Williams and Popay’s welfare research framework. The thesis examines mothers’ day-to-day worlds, the opportunities and constraints they navigate, the policies and institutions which shape their opportunities, the political framing of those policies, and wider social and economic transformations. In their negotiation of the social security system, mothers are striving for recognition of autonomy and care. They want their capacity to determine for themselves how to live their lives to be acknowledged. They would like the social contributions they make through employment, education and voluntary work to be recognised. They struggle for their unpaid work caring for their families to be valued. They wish that they had sufficient material resources to care well for their families. The thesis develops a theoretical framework to examine these struggles drawing on the work of Honneth, Fraser, Lister, Sennett, Fisher and Tronto, Daly and Lewis. This multi-level, everyday life analysis reveals the possibility of reframing the social security system around mutual respect.
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Macfarlane, Chelsea E., University of Western Sydney e School of Applied Social and Human Sciences. "A comparison of the predictors of hepatitis B vaccination acceptance amongst health care and public safety workers in Australia". THESIS_XXX_ASH_MacFarlane_C.xml, 2001. http://handle.uws.edu.au:8081/1959.7/784.
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This thesis examines the results of a hepatitis B vaccination questionnaire study that was completed by medical officers, nurses, carers of the developmentally disabled, and correctional officers in the Greater Western Sydney area of New South Wales, Australia. The main aim of the study was to contrast these four high risk occupational groups for their acceptance of hepatitis B vaccination, seroconversion status, and behavioural, attitudinal, motivational and institutional determinants of their vaccination status. The results of the thesis revealed that medical officers and nurses were the most likely to be tested and vaccinated for seroconversion, while DD carers and correctional officers had the largest number of Not Vaccinated respondents. The findings of the questionnaire are discussed in some detail. It is also suggested that groups differ in the degree of hepatitis risk anxiety they experience as well as the degree of control felt over their health status. A number of indications for personal, institutional and governmental interventions to increase vaccination levels are discussed.Doctor of Philosophy (PhD)
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Eades, Anne-Marie. "Factors that influence participation in self-management of wound care in three Indigenous communities in Western Australia: Clients' perspectives". Eades, Anne-Marie (2008) Factors that influence participation in self-management of wound care in three Indigenous communities in Western Australia: Clients' perspectives. Masters by Research thesis, Murdoch University, 2008. http://researchrepository.murdoch.edu.au/707/.
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The purpose of this study was to identify any barriers or enablers as influences on wound care self-management by Indigenous people. A qualitative, interpretive study sought to investigate how participants perceived their wounds and their general health, and to identify the influences on them accessing wound care services.
There is a dearth of information on culturally appropriate practice in wound management for Indigenous Australians. This research project was therefore significant in attempting to bridge the gap in nursing knowledge of Indigenous clients' perceptions of barriers and enablers for seeking wound care services,especially in relation to lower leg ulcers. The lack of culturally sensitive wound management practices potentially impacts on Indigenous clients' behaviours in seeking treatment from their health service providers.
Participant observations and semi-structured interviews with the research participants investigated the management of their wounds, and the ways in which their culture influences wound management. The main aim was to understand participants' comprehension of the importance of wound care through reflection. Understanding the enhancing or obstructive influences on wound management practices was expected to provide a foundation for teaching self care of wounds in Indigenous populations and inform health professionals' approach to health education.
The data were analysed using thematic analysis, which generated common themes related to the research questions. These themes are: visibility, of the problem,4 perceived versus actual level of knowledge, acceptance of co-morbid health conditions and pre-determined path of ill health. These findings indicated that in one region, participants' perception of poor health was related to visibility of the problem. Participants chose to have their visible wounds managed by Silver Chain Nursing Association, whereas Diabetes and Hypertension and any other non-visible disorders were seen as appropriate to the Aboriginal Medical Service (AMS). Further to this finding, most participants displayed a sense of helplessness and hopelessness when sharing information about their diagnosis of diabetes, believing this was the norm. Many also believed that having a strong family history of a particular disease resulted in the participants also inheriting the disease. During post interview educational sessions many of the Indigenous participants were surprised by the evidence based-research reported to them by the researcher that diabetes is a manageable disease with life style changes.
Another issue highlighted was the perceived level of knowledge the participants had about wound care. Reassurance was given by the participants that their level of knowledge about how to manage their wounds was adequate. However, none of the participants were concerned about the length of time that their wound/s had or were being managed, between 3 months and 5 years. This acceptance that although a wound is not getting any worse and not getting any better was the norm is cause for concern, and indicates a low level of health literacy. This theme was 'perceiving an imbalance in perceptions of wound care knowledge with actual knowledge'.
The most important recommendation from the study findings is the need to consider health literacy more carefully in the development of health promotion and health education for Indigenous clients with wounds.
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Macfarlane, Chelsea Elizabeth. "A comparison of the predictors of hepatitis B vaccination acceptance amongst health care and public safety workers in Australia /". View thesis, 2001. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20031222.150943/index.html.
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Thesis (Ph.D.) -- University of Western Sydney, 2001."A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, University of Western Sydney" Bibliography : leaves 193-208.