Baby steps or giant strides?

In its 2014 review of the child care sector, the Productivity Commission revealed that parents of one in six children were struggling to access child care services in their area, with just over one half of parents indicating that a failure to secure child care was hindering their ability to meet work commitments. This paper considers the childcare and family policies currently being considered by the Australian Parliament, and assesses how those policies stack up against the best practice features of other nations

A Critical Exploration of the Use of Mental Health Records in Rape Trials

Commentators discussing the cross-examination of rape complainants have tended to focus on sexual history evidence and character evidence more generally. The defence use of psychiatric evidence has, in contrast, received very little attention to date. This thesis examines the use of women’s mental health records in rape trials, arguing that such use is a further demonstration of the resilient focus on the complainant’s character and behaviour in rape trials. Against a backdrop of wide stigmatisation and victimisation of those with mental health problems, this thesis aims to analyse the existing literature on use of mental health records in rape trials, while also serving to highlight the need for more sustained critical research and reflection on the treatment of women with mental health problems within the criminal justice system. The thesis argues that the law governing the use of mental health records in rape trials is significantly flawed and requires reform, taking inspiration from the law in two other jurisdictions – Canada and New South Wales

Counting the Costs: Sustainable funding for the ACT community services sector

This report informs development of more sustainable models of resourcing for the ACT community services sector. It presents a comprehensive picture of the costs involved in delivering community services, the cost pressures experienced by community organisations in the ACT, and ways to ensure funding is sustainable and at levels that meet community needs

Culture, courage and compassion: exploring the experience of student nurses on placement abroad

BackgroundNursing is emotional work and learning how to manage their emotions is a valuable part of nurse education. As the workforce becomes increasingly mobile nurses will care for people from diverse cultures and backgrounds. The development of cultural competence and a global mind-set is therefore a valuable asset and engagement in study abroad through overseas clinical placement can help to facilitate this. This study set out to explore the experience of student nurses involved in an exchange programme between Scotland and Western Australia. A particular focus was on the emotional aspects of the experience, responding to challenges and provision of care in a different healthcare setting.MethodsA descriptive qualitative strategy of enquiry was used and semi structured interviews undertaken with a sample of 10 student nurses using emotional touch points. The interviews were recorded, transcribed verbatim and subjected to thematic analysis using NVIVO 11.ResultsFive main themes were identified. Making it happen, connections, feeling vulnerable, culture and assertiveness and affirmation.ConclusionsThis study makes a unique contribution to the nursing student experience of overseas placement as it focuses on the emotional elements. The study shows that the experience of care delivery in an overseas placement has many benefits but also challenges. Management of emotion is required and transition to a different healthcare system can be stressful. Cultural differences were more marked than anticipated but when students responded by questioning, respectful assertiveness and provision of compassionate care there were clear rewards. These manifested as a sense that caring is a privilege and affirmation of career choice

Illuminating the importance of craftsmanship in compassionate caring and facilitating its development in student nurses

This thesis provides a critical reflection on my original contributions to knowledge in the field of nursing practice and nurse education over the last decade. Collectively my eight selected papers demonstrate an ongoing and incrementally developing conceptual approach. This culminates in the presentation, within my final capstone paper, of my original recombinant innovation. In this paper, application of the innovation is articulated through a compassionate craftsmanship relational model, which fuses multivalent ideas from the fields of compassionate care and craftsmanship. Combining these disparate and frequently tacit elements together required diligence and courage in a world where fixed solutions are increasingly prominent. My innovative relational model is, however, importantly designed to be used as a heuristic device to promote reflection within nurse education and compassionate care. The papers are grouped into three sets. The initial group of papers focus on the nature of nursing expertise and compassionate care. They illuminate important elements of care practice made possible through possession and application of often hidden tacit knowledge stored up in the mind of the nurse. The implicit underpinning concepts revealed in this research became progressively more explicit and well-articulated over the ten-year period as I developed my approach and thinking in relation to similarities between compassionate nursing expertise and craftsmanship. A second suite of papers shares a common methodological focus where qualitative approaches were used to gather stories in a novel way. The “emotional touch-points” method was used to capture stakeholder experiences of compassionate care and caring. The stories served as a powerful mechanism to gain insights into the lived experience of others. This approach held pragmatic value for patients, nurses and students, because the stories transformed thinking and motivated action, importantly feeding into the golden thread of compassionate craftsmanship. The third set of papers demonstrates my interest in applying ideas from my practice-based research to educational environments by integrating the findings and stakeholder stories in a range of original pedagogical initiatives. Through implementation of these novel approaches, development in compassionate care and nursing ‘know-how’ was facilitated in student nurses. The educationally oriented papers articulate the positive impact and contribution to the fields of nursing and nurse education achieved through supporting learning in this area

Association Between Method of Prescribing and Primary Nonadherence to Dermatologic Medication in an Urban Hospital Population

Importance Prescription underuse is associated with poorer clinical outcomes. A significant proportion of underuse is owing to primary nonadherence, defined as the rate at which patients fail to fill and pick up new prescriptions. Although electronic prescribing increases coordination of care and decreases errors, its effect on primary nonadherence is less certain. Objectives To analyze factors associated with primary nonadherence to dermatologic medications and study whether electronic prescribing affects rates of primary nonadherence. Design, Setting, and Participants A retrospective review of medical records was conducted from January 1, 2011, to December 31, 2013, among a cohort of new patients prescribed dermatologic medications at a single, urban, safety-net hospital outpatient dermatology clinic. Main Outcomes and Measures The primary outcome was the overall rate of primary nonadherence, defined as filling and picking up all prescribed medications within a 1-year period, and the difference in primary nonadherence between patients who received electronic prescriptions and those who received paper prescriptions. Secondary outcomes included the association of primary nonadherence with sex, age, relationship status, primary language, race/ethnicity, and number of prescriptions. Results A total of 4318 prescriptions were written for 2496 patients (mean [SD] age, 47.7 [13.2] years; 849 men and 1647 women). The overall rate of primary nonadherence was 31.6% (n = 788). Based on multivariable analysis, the risk of primary nonadherence was 16 percentage points lower among patients given an electronic prescription (15.2%) than patients given a paper prescription (31.5%). Primary nonadherence decreased with age (<30 y, 38.9%; 30-49 y, 35.3%; and 50-69 y, 26.3%), and then increased in elderly patients 70 years and older (31.9%). Of patients who were given 1, 2, 3, 4, or 5 prescriptions, rates of primary nonadherence were 33.1%, 28.8%, 26.4%, 39.8%, and 38.1%, respectively. Primary nonadherence decreased with age but then increased in elderly patients. Patients identifying English as their primary language had the highest rate of primary nonadherence (33.9%) compared with Spanish (29%) or other speakers (20.4%). Conclusions and Relevance Compared with paper prescriptions, electronic prescriptions were associated with less primary nonadherence. Number of prescriptions, language, race/ethnicity, and age were associated with increased rates of primary nonadherence. Efforts must be made to understand why primary nonadherence occurs, identify patients prone to primary nonadherence, and simplify medication regimens to maximize adherence and quality of care