Yvonne Parry

An investigation of culturally competent terminology in healthcare policy finds ambiguity and lack of definition.

Objective : This research explored how the concept of cultural competence was represented and expressed through health policies that were intended to improve the quality and efficacy of healthcare provided to families from culturally marginalised communities, particularly women and children with refugee backgrounds.

Using mixed methods to analyse barriers to primary paediatric health access

Abstract This paper describes the way in which a mixed methods approach might provide a knowledge base to understand some of the factors involved in access to paediatric healthcare. The paper addresses the potential for this approach to start to build an evidence-informed understanding of a public policy issue. Our research tracked the increase in paediatric presentations at the Woman’s and Children’s Health Service Emergency Department (ED) in South Australia for primary care illness events. The use of ED for primary care services is an increasing issue for emergency service provision. The mixed methods used the Hospital Admission Status (HAS), Paediatric ED data, analysis of the South Australian Social Health Atlas for demographic and epidemiological data, and triage priority information. This quantitative analysis informed the use of interviews with parents, community health providers and emergency health professionals. Sequencing allowed the researchers to integrate the question over time and revealed policy deficits in health access in Australia.

A Comparison of Sound Levels in Open Plan Versus Pods in a Neonatal Intensive Care Unit

Objective: The objective of this study was to compare the noise levels recorded in two different neonatal intensive care unit (NICU) settings: a pod and an open plan NICU located in the same hospital. Background: The NICU is a busy environment with ambient noise levels that often exceed established recommendations. This noise deleteriously affects the physiological stability and developmental outcomes of sick and preterm infants. Pods have reduced numbers of cots (in this case, 6) compared to open plan NICUs (in this case, 11), yet the noise levels in pods have not been reported. Method: This study compared real-time decibel (dB) levels in an A-weighted scale, captured continuously by sound dosimeters mounted in both NICU settings for a period of 4 weeks: a pod setting and an open plan NICU. Researchers also collected observational data. Results: The average noise level recorded in the pod was 3 dBs less than in the open plan NICU. This result was statistically significant. However, dB recordings in both areas were over the recommended limits by 4–6 dBs, with isolated peaks between 74.5 dBs (NICU) and 75.9 dBs (pod). Observational data confirmed this correlation. Conclusions: Further research to evaluate interventions to decrease the noise levels in both settings are needed, especially during times of peak activity. Staff working in these settings need to be more aware that control of acoustic levels is important in the neuroprotection of neonates. Coupling this with careful consideration to structural components and evidence-based design planning may contribute to lowering dB levels in the NICU environment.

Deprivation and its impact on non-urgent Paediatric Emergency Department use: are Nurse Practitioners the answer?

AIMS This article reports on the quantitative findings from a large mixed method study that determined the extent to which the provision of alternatives to an Emergency Department and Index of Relative Social Disadvantage score influenced non-urgent paediatric Emergency Department use. BACKGROUND In Australia, there is an increasing use of Emergency Departments for the provision of non-urgent care that may be better serviced in the community. Further, despite the plethora of literature describing the characteristics of non-urgent users of Emergency Departments the link to social and community characteristics remains under explored. DESIGN This 2010 retrospective analysis of the Hospital Admission Status data from the paediatric Emergency Department provided the information on attendance types and numbers along with postcode details. The postcodes in conjunction with Australia Bureau of Statistics data provided the levels of deprivation from the Index of Relative Social Deprivation scores. METHOD A logistic regression analysis determined the levels of influence of deprivation and General Practitioner or Nurse Practitioner provision on the use of Emergency Departments for non-urgent care. FINDINGS Rates of use for non-urgent care is higher for populations who come from areas of deprivation and have limited primary care services, such as low levels of General Practitioners. Children from areas of high deprivation and limited access to primary care were up to six times more likely to use Emergency Department for non-urgent care. CONCLUSIONS Deprivation impacts on the use of paediatric Emergency Departments for non-urgent care even in countries like Australia where there is government subsidized health care.

A scoping study: children, policy and cultural shifts in homelessness services in South Australia: are children still falling through the gaps?

Homeless families are the fastest growing segment of the homelessness population. Homelessness services are often the first to know when children are at risk of disengagement with health, welfare and education services. Changes to Australian policy to explicitly attend to the needs of children are attempts to address the complexity of, and provide better outcomes for, homeless children. There are mounting levels of evidence describing some of the needs of children who are homeless. Using the scoping study methodological framework, this review of academic and grey literature identified the extent to which service providers provide for the needs of homeless children. The literature search was conducted from September 2012 to April 2013 using ProQuest, Science Direct, Sage and OVID databases. Therefore, the objectives of this scoping study were to: (i) identify the specific needs of children in homelessness; (ii) describe recent changes in policy relating to care for children in homelessness services; (iii) explore the evidence on how service providers can enact care for children in homelessness services; (iv) identify the types of practice changes that are needed to optimise outcomes for children; and (v) identify the gaps in service delivery. This article describes the Australian policy changes and explores the potential impact of subsequent sector reforms on the internal practices in front-line homelessness services, in order to overcome structural and systemic barriers, and promote opportunities for children in homeless families. This scoping study literature review contributes to the understanding of the impact of policy change on front-line staff and suggests possible practice changes and future research options.

Educating professionals who will work with children in the early years: an evidence-informed interdisciplinary framework

The first five years of a child’s life are irrefutably important, establishing life-long health, social and economic outcomes. To optimize these outcomes, global policy is directing professionals from a range of disciplinary backgrounds to work more collaboratively than ever before with children in the early years. Such collaborations have proven problematic as individual disciplines and pre-service education requirements vary widely. Using Community-Based Participatory Research and Diffusion of Innovation approaches, this study aimed to develop an educational framework for professionals working with children in the early years and their families, to begin a cultural change for interdisciplinary collaboration and participation across the early years. Systematic reviews, modified Delphi rounds and focus groups identified the diverse demands of multiple professions, qualification levels and workforce agendas, as well as highlighting shared outcomes, knowledge and intentions across disciplines.