Judith D. Pugh

The use of unregulated staff: Time for regulation?

Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurses with unskilled nursing support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. We argue that it is timely to consider regulation of nursing support workers with their role and scope of practice clearly defined. Further, the addition of these workers in a complementary model of care (rather than substitutive model) should also be explored in future research, in terms of impact on patient and nurse outcomes.

Hepatitis C and the Australian news media: A case of ‘bad blood’

As the producer of community education resources and editor of the newsletter for the Hepatitis Council of Western Australia (HCWA) from 1997 to 2003, I was concerned about media representations of people living with hepatitis C. Recognizing that the news media represent one of the most common sources of medical and health-related information for patients (Newnham et al. 2005; Van Der Weyden and Armstrong 2005, 188), non-government hepatitis C councils in Australia endeavour to communicate hepatitis C-related information to the community via the mass media when advocating on behalf of hepatitis C-affected people. In March 2000, the Hepatitis C Council of New South Wales launched the first Australian hepatitis C public awareness campaign. Since then, other State and Territory hepatitis C councils have run hepatitis C awareness weeks that attract patchy coverage by the mainstream print and broadcast media (Hepatitis C Council of Victoria 2002). Moreover, Faye (2000), formerly a volunteer counsellor at the HCWA, found that participants in her study blamed the media for the ‘penalization’ of people infected with hepatitis C. Not only was the media the main source of information about hepatitis C for these people but also the source of considerable emotional harm. Here was an issue about which hepatitis C community groups could take action. At the outset, their critique of particular news media texts could consider what is and is not said about hepatitis C, and those affected by hepatitis C, and how representations are constructed. In this paper, textual material from a study that interrogated the power relations of professional experts evident in hepatitis C-related health policy and media discourses in Australia (Pugh 2006) is used to look at how news stories apportion different moral positions for people with hepatitis C based on modes of infection and their role in these. To date, there has been little research about the media’s role in shaping the discourse on hepatitis C in Australia. Krug (1997) found that selected Australian television news, current affairs, and newspaper stories, published between 1994 and 1995, focused on the burden the disease imposes on the healthcare system and the moral discourse of intravenous drug use. Much as Treichler (1987, 263–4) previously described HIV/AIDS, Krug (1995, 310; 1997, 92) cast hepatitis C as an epidemic of a transmissible disease and as a signifier of disease or contagion with signifiers coming from diseases such as HIV/AIDS and portrayals of ‘otherness’ such as injecting drug users. Injecting drug use is also conspicuous as the main means of transmitting hepatitis C in a number of news articles published in daily newspapers in New South Wales and Victoria from January

The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data

OBJECTIVES The aim of this study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data. DESIGN Logistic regression modelling was used with linked administrative health data to examine the association between seven adverse patient outcomes and use of assistants in nursing utilising a pre-test/post-test design. Outcomes included were in-hospital 30-day mortality, failure to rescue, urinary tract infection, pressure injury, pneumonia, sepsis and falls with injury. SETTING Eleven acute care metropolitan hospitals in Western Australia. SAMPLE Patients were retained in the dataset if they spent any time on a medical, surgical or rehabilitation ward during their admission and excluded if they only spent time on other ward types, as the outcomes used in this study are only validated for these patient populations. There were 256,302 patient records in the total sample with 125,762 in the pre-test period (2006-2007) and 130,540 in the post-test period (2009-2010). RESULTS The results showed three significant increases in observed to expected adverse outcomes on the assistant in nursing wards (failure to rescue, urinary tract infection, falls with injury), with one significant decrease (mortality). On the non-assistant in nursing wards there was one significant decrease (pneumonia) in the observed to expected adverse outcomes and one significant increase (falls with injury). Post-test analysis showed that spending time on assistant in nursing wards was a significant predictor for urinary tract infection and pneumonia. For every 10% of extra time patients spent on assistant in nursing wards they had a 1% increase in the odds of developing a urinary tract infection and a 2% increase in the odds of developing pneumonia. CONCLUSION The results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which clearly defines their role, scope of practice, and working relationship with registered nurses, and the impact on patient care should be monitored.

Feldenkrais method empowers adults with chronic back pain.

A phenomenological approach was used to explore the experiences of 11 adults attending Awareness Through Movement lessons in the Feldenkrais Method to manage chronic-episodic back pain. Semistructured interviews were analyzed. The results suggest improving self-efficacy through somatic education and awareness potentially offers a way forward given the back pain epidemic.

Rapid evidence assessment of approaches to community neurological nursing care for people with neurological conditions post-discharge from acute care hospital

Neurological conditions represent leading causes of non-fatal burden of disease that will consume a large proportion of projected healthcare expenditure. Inconsistent access to integrated healthcare and other services for people with long-term neurological conditions stresses acute care services. The purpose of this rapid evidence assessment, conducted February-June 2016, was to review the evidence supporting community neurological nursing approaches for patients with neurological conditions post-discharge from acute care hospitals. CINAHL Plus with Full Text and MEDLINE were searched for English-language studies published January 2000 to June 2016. Data were extracted using a purpose-designed protocol. Studies describing community neurological nursing care services post-discharge for adults with stroke, dementia, Alzheimers disease, Parkinsons disease, multiple sclerosis or motor neurone disease were included and their quality was assessed. Two qualitative and three quantitative studies were reviewed. Two themes were identified in the narrative summary of findings: (i) continuity of care and self-management and (ii) variable impact on clinical or impairment outcomes. There was low quality evidence of patient satisfaction, improved patient social activity, depression scores, stroke knowledge and lifestyle modification associated with post-discharge care by neurological nurses as an intervention. There were few studies and weak evidence supporting the use of neurology-generalist nurses to promote continuity of care for people with long-term or progressive, long-term neurological conditions post-discharge from acute care hospital. Further research is needed to provide role clarity to facilitate comparative studies and evaluations of the effectiveness of community neurological nursing models of care.

Issues impacting on enrolled nurse education for Aboriginal and Torres Strait Islander students: a discussion

Background: Achieving increased participation of Aboriginal and Torres Strait Islander peoples in Australia’s health workforce, particularly nursing, is federal government policy imperative. However, the uptake of Aboriginal and Torres Strait Islander students into nursing has stalled and their attrition from tertiary nursing courses is considerably higher than for other students. Aim: To alert the profession to issues impacting enrolled nursing education for Aboriginal and Torres Strait Islander students. Design: Discussion paper. Results: Studies of Aboriginal and Torres Strait Islander students mainly focus on tertiary education for registered nurses whereas vocational education and training (VET) for enrolled nurses is usually overlooked. It is generally assumed that the issues influencing the recruitment, attrition, and retention of Aboriginal and Torres Strait Islander students in higher education universities and other institutions similarly impact enrolled nursing students in the VET sector. Conclusion: Research that contributes robust evidence-based knowledge specifically on strategies addressing issues in enrolled nursing education for Aboriginal and Torres Strait Islander students and their employment uptake is required.

Impact and costs of home-based trial of void compared with the day care setting.

AIMS This paper presents the relative merits and comparative costs of conducting trial of void using Hospital-In-The-Home vs. the Day Procedure Unit. BACKGROUND Hospitals increasingly discharge patients with acute urinary retention with indwelling urinary catheters. For these to be removed and patients supported to return to normal urinary function, outpatient or in-home services are used. To date, the relative effectiveness and costs of Hospital-In-The-Home care and Day Procedure Unit care for trial of void have not been examined. DESIGN This retrospective study used a static-group comparison design. METHODS Hospital administrative data from 1 February 2009-30 March 2011 for patients having trial of void in the Day Procedure Unit (n = 107) and Hospital-In-The-Home (n = 163) of a tertiary hospital in Western Australia were compared in terms of patient outcomes and costs. RESULTS Day Procedure Unit patients had longer wait times than Hospital-In-The-Home patients; there was no difference between the two groups for average per patient days of service or successful first trials. Hospital-In-The-Home care did not increase the overall period of care. Per patient average ward-equivalent cost in the Day Procedure Unit was A

Western Australia facing critical losses in its midwifery workforce: A survey of midwives' intentions

396 higher than the Hospital-In-The-Home ward-equivalent cost. The average cost saving per patient for Hospital-In-The-Home care including trial of void cost and emergency department visits was A

Barriers and enablers to retention of Aboriginal Diploma of Nursing students in Western Australia: An exploratory descriptive study.

117. CONCLUSION Patient outcomes from Hospital-In-The-Home trial of void in low-risk patients were comparable to those of Day Procedure Unit care and less costly. Hospital-In-The-Home care for this well-defined procedure could permit more efficient management of patient throughput.