Expressive phenomenology and critical approaches in the classroom: process and risks for students of health sciences

This article explores the use of expressive phenomenological and critical approaches to the teaching of health policy to a large class of first year health professional students studying both internally and through distance education. The phenomenological approach to classroom teaching attempts to provide students with opportunities to immerse themselves in the lived experiences of populations and individuals who are ill and in need of care. The critical approach brings the political, social and cultural realities of professional practice into the classroom discussion and reflection. The transition from the expressive phenomenological to critical analysis requires careful management by the teacher when reacting to the mood, responses and capacities of students. Managing these processes online for students studying at a distance presents additional pedagogical issues. These are: the problem of capturing ‘real time’ mood, managing the chaos of multiple student narratives, allowing time to dwell on the phenomena and dealing with the impact of violent films

Using mixed methods to analyse barriers to primary paediatric health access

Author version made available in accordance with the publisher's policy.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 Emergency Department 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

Are the new General Practitioner Plus centers the correct government response to a lack of pediatric after-hours care for parents?

Providing timely and appropriate primary health care after-hours is a major policy issue confronting many Western governments. Increasingly, consumers are seeking care from emergency departments, for health problems that would be better serviced by a primary care professional. Mindful of this issue both State and Federal government in Australia have established and funded General Practice Super Clinics to provide after-hours care in low socioeconomic areas for vulnerable populations. A key policy requirement of funding is the provision of after-hours care. This paper takes a case study of parents seeking after-hours, non-emergency care for their sick child. This study illustrates the way in which GP Super Clinics provide an appropriate response to this issue, but the analysis questions whether or not this can be achieved under the current arrangements

Rationed, Missed, or Nursing Care Left Undone: a comment from the Antipodes

Editorial to volume 10, issue 1

Hospitals caring for rural Aboriginal patients: holding response and denial

Open Access article published under a CC-BY-NC-ND licence: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/deed.en_US).Objective To investigate how policy requiring cultural respect and attention to health equity is implemented in the care of rural and remote Aboriginal people in city hospitals. Methods Interviews with 26 staff in public hospitals in Adelaide, South Australia, were analysed (using a framework based on cultural competence) to identify their perceptions of the enabling strategies and systemic barriers against the implementation of official policy in the care of rural Aboriginal patients. Results The major underlying barriers were lack of knowledge and skills among staff generally, and the persistent use of ‘business as usual’ approaches in their hospitals, despite the clear need for proactive responses to the complex care journeys these patients undertake. Staff reported a sense that while they are required to provide responsive care, care systems often fail to authorise or guide necessary action to enable equitable care. Conclusions Staff caring for rural Aboriginal patients are required to respond to complex particular needs in the absence of effective authorisation. We suggest that systemic misinterpretation of the principle of equal treatment is an important barrier against the development of culturally competent organisations. What is known about this topic? The care received by Aboriginal patients is less effective than it is for the population generally, and access to care is poorer. Those in rural and remote settings experience both severe access barriers and predictable complexity in their patient care journeys. This situation persists despite high-level policies that require tailored responses to the particular needs of Aboriginal people. What does this paper add? Staff who care for these patients develop skills and modify care delivery to respond to their particular needs, but they do so in the absence of systematic policies, procedures and programs that would ‘build in’ or authorise the required responsiveness. What are the implications for practitioners? Systematic attention, at hospital and clinical unit level, to operationalising high policy goals is needed. The framework of cultural competence offers relevant guidance for efforts (at system, organisation and care delivery levels) to improve care, but requires organisations to address misinterpretation of the principle of equal treatment

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

‘This is the peer reviewed version of the following article: Parry Y.K., Ullah S., Raftos J. & Willis E. (2015) Deprivation and its impact on non-urgent Paediatric Emergency Department use: are Nurse Practitioners the answer? Journal of Advanced Nursing 00(0), 000–000. doi: 10.1111/jan.12810, First published online 18 SEP 2015. This item is under embargo according to publisher policy and will be available from 19 SEP 2016Aims: This paper 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 ED 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 6 times more likely to use Emergency Department for non-urgent care. Conclusions: Deprivation impacts on the use of paediatric ED for non-urgent care even in countries like Australia where there is government subsidised health care

The cultural relations of water in remote South Australian towns

Water is an increasingly scarce resource and the decline in rainfall presupposes people and communities adapting to live in drier, and very different, social and environmental conditions. In rural and remote South Australia residents have always considered water a reflexive resource that requires them to consider their relationship to water and its availability and access. These are material concerns. Yet, lifestyle, identity, sense of place and community is profoundly shaped by the inclusion of ‘water’ in one’s habitus. ‘Water’ is also a social concern and its material management arises within cultural relations

Aboriginal perceptions of incompatibility of location, lifestyle and water resources

This paper conveys the verbal account of Nepabunna community’s perceptions of their water resources, and the usability and sustainability of their water supply. Nepabunna, a remote Aboriginal community in South Australia relies on meagre rainfall for its potable supply. Non-potable groundwater is reticulated to community buildings to make up for the shortage created by the paucity of potable water. One of the issues raised by the community is the incompatibility of its’ location with the available water resources. It is estimated that the groundwater resources will not be able to sustain the community beyond ten to fifteen years. Results indicate an incompatibility between available water and lifestyle, that is, despite the paucity of water, the community has flush toilets and water-based air coolers with the resultant per capita consumption going up to about 836 l/p/d. The community has high expectations in terms of water supply, and for a way forward to be found changes will have to occur in water management, and the community engaged to enable ownership and acceptance of future water supply options

Identification of the severe sepsis patient at triage: a prospective analysis of the Australasian Triage Scale

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Objective This study aims to investigate the accuracy and validity of the Australasian Triage Scale (ATS) as a tool to identify and manage in a timely manner the deteriorating patient with severe sepsis. Methods This was a prospective observational study conducted in five sites of adult patients. Keywords and physiological vital signs data from triage documentation were analysed for the ‘identified’ status compared with confirmed diagnosis of severe sepsis after admission to the intensive care unit. The primary outcome is the accuracy and validity of the ATS Triage scale categories to identify a prespecified severe sepsis population at triage. Secondary outcome measures included time compliance, antimicrobial administration and mortality prediction. Statistical analysis included parameters of diagnostic performance. Adjusted multivariate logistic regression analysis was applied to mortality prediction. Results Of 1022 patients meeting the criteria for severe sepsis, 995 were triaged through the emergency department, 164 with shock. Only 53% (n=534) were identified at triage. The overall sensitivity of the ATS to identify severe sepsis was 71%. ATS 3 was the most accurate (likelihood ratio positive, 2.45, positive predictive value 0.73) and ATS 2 the most valid (area under the curve 0.567) category. Identified cases were more likely to survive (OR 0.81, 95% CI 0.697 to 0.94, p4 (OR 1.63, 95% CI 1.10 to 2.89, p<0.001) and ATS 1 category (OR 1.55, 95% CI 1.09 to 2.35, p<0.005). Conclusions The ATS and its categories is a sensitive and moderately accurate and valid tool for identifying severe sepsis in a predetermined group, but lacks clinical efficacy and safety without further education or quality improvement strategies targeted to the identification of severe sepsis