Stella Stevens

Caring for People with a Mental Disability at Home: Australian Carers' Perceptions of Service Provision

This study investigates carer perceptions of the adequacy of assistance received by comparing two populations: those with a mental disability and those with a physical disability in Australia by using data representing 12.5% of the total population. This very large sample provides robust evidence for the study’s findings. Of those caring for individuals with severe core disabilities, 21.6% of those with a mental disability compared to only 8.3% of carers of those with a physical disability reported inadequate service assistance. Greater involvement of consumers and their families in health care service planning will provide opportunities to deliver more appropriate services and enhance equities within this sector.

Substitution across professions within the home care sector: an investigation of nursing and allied health services

OBJECTIVEnThe service type offered by a home care agency contracted by the Queensland government is not based on the qualifications of the worker providing the service, but the service itself. This allows agencies to substitute certain levels and categories of labour in order to provide a service to meet their contract obligations. This study investigated evidence of labour substitution between nursing and allied health services.nnnMETHODSnCorrelation and regression analysis was performed on the data collected from 218 clients of a branch of a community-based service agency operating nationally in Brisbane, Australia, during April, May and June 2005.nnnRESULTSnThe results of the regression analysis revealed that when either allied health or nursing time rose by 10%, all else held constant, it was predicted that the other would fall by 4%. The subcategories, registered/enrolled nursing and physiotherapy, appeared to drive the inverse relationship between nursing and allied health service time. Registered/enrolled nursing service time was more sensitive to changes in physiotherapy rather than the other way around.nnnCONCLUSIONSnThe higher labour turnover among allied health staff compared with the nursing staff reported by the agency implies a substitution of labour between the two professions to ensure that the needs of clients are met. Health policy makers and health care professional educators need to acknowledge that workforce shortages will inevitably reshape professional boundaries. Leaving labour-force substitution undiscussed and unplanned may compromise the quality and safety of care.

Addressing Organisationally Induced Stress in a Police Jurisdiction: An Australian Case Study

Over 3,500 employees in a police jurisdiction have participated in a health promotion initiative designed to encourage staff to take responsibility for their health. This project was part of a range of initiatives to address workplace stress and involved physical and medical testing and advice. This paper presents the results of interviews with 83 participants about the impact of the programme on their health behaviours and the extent to which they feel it has helped them manage workplace stress better. Although health promotion in the workplace is often criticised as a common response by organisations seeking to reduce stress for their workforce by placing the responsibility for that back on to the individual, this study demonstrates that there can be several positive outcomes. Not least of these is a reported increase in morale due to the perception that the organisation acknowledged that stress was generated by the workplace and was acting to provide support. The vast majority of those interviewed also reported changed health behaviours. The factor which reduced the participation rate (38 per cent) in the opinion of those interviewed was, however, a lack of trust on the part of workers about the objectives of the programme. The study reported here contains information useful to those both planning workplace health promotion initiatives and those organisations seeking to reduce workplace stress.

'Closing the Loop': the role of health care leaders in integrating research and practice

The study reported here examines what health care leaders do to implement the routine integration of information into clinical practice decision making. Clinical leaders of a major Australian tertiary teaching hospital were interviewed. The study found that there is wide variation in the extent to which information is routinely used to inform practice. Those leaders who successfully integrated information used some common strategies. The ownership of information may be the single most powerful factor in clinical leaders ability to encourage its use. A lack of trust, inappropriate systems and a fear of unfavourable consequences were identified as issues. The findings have implications for policy makers, hospital administrators and clinical leaders and question the effectiveness of centralised approaches to driving clinical change.