Standardizing the care of detox patients to achieve quality outcomes

Providing appropriate treatment for detoxification patients is both challenging and difficult because alcohol abuse and dependence are largely underestimated in the acute hospital setting. Alcohol withdrawal syndrome is treated not only by addictionologists on chemical dependency units, but also by primary care physicians in acute inpatient settings. The need for consistent inpatient treatment through the use of identified protocols can help provide safe and effective care. The need for consistent, inpatient medical-surgical detoxification treatment in our organization became apparent with the staff's identification of patient care concerns. Using an organizational approach, a multidisciplinary team was created to standardize the care of detoxification patients, beginning with patient admission and ending with discharge and referral for outpatient management. Standardization would ensure consistent assessment and intervention, and improve communication among the clinical team members. A protocol was developed for both the emergency department and the inpatient units. The goals of the team were to decrease the adverse events related to detoxification, such as seizures and aggression, and provide a consistent method of treatment for staff to follow.     

Examining the Impact of Pre‐Implementation Expectations on Post‐Implementation Use of Enterprise Systems: A Longitudinal Study

This article builds upon the technology acceptance model and theories of technology sensemaking to explore pre‐enterprise system adoption expectations and post‐enterprise system adoption outcomes in a longitudinal setting. Building on the exploitation and exploration paradigm, we propose that task productivity and task innovation expectations are the key drivers of users’ pre‐adoption enterprise system usage intention. Further, we argue that the enterprise system facilitates generation of a common knowledge base that may encourage a more integrated organizational culture and promote shared understanding among employees. Considering the distinction between mandatory and voluntary contexts, we propose that user acceptance of the enterprise system at the pre‐ and post‐adoption stages will mediate these relationships in a mandatory context. The results show that the influence of pre‐adoption expectations regarding task productivity and task innovation on intention to use an enterprise system is mediated by user acceptance of the enterprise system. Intention to use an enterprise system is positively related to actual use. At the post‐adoption stage, the influence of actual use on shared understanding is mediated by user acceptance of an enterprise system and enterprise system use has a direct negative impact on task efficiency in the initial period after implementation. Overall, the results highlight that user acceptance at both pre‐ and post‐adoption stages are critical factors when usage is mandatory. These findings suggest a number of important implications for research and for managerial action.     

Developing a Core Competency Model and Educational Framework for Primary Maternity Services: a national consensus approach

BackgroundAn appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals.ParticipantsKey stakeholders from professional organisations and providers of services related to maternity care and consumers of services.MethodsA national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation.FindingsA national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups’ education and practice.ConclusionsThe Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services.     

Abuse and older lesbian,gay bisexual,and trans (LGBT) people: a commentary and research agenda

With increasing visibility of older lesbian, gay, bisexual and trans (LGBT) people, there is an urgent need to understand abuse in their lives. This is an under-researched area, which this scoping study (based on a literature review and a small subset of data taken from a larger project) serves to demonstrate. The content of this article formed the basis of a paper presented at a workshop on ‘LGBT Elder Abuse’ held at Keele University(UK) in 2017, convened and chaired by the author. It considers LGBT elder abuse in terms of polyvictimisation, intersectionality and the abuse of power. The identifies knowledge gaps, proposes a research agenda, and explains why such an agenda matters. In particular, the need for researchers of elder abuse, LGBT domestic abuse and organisational abuse to cut across their traditional boundaries of inquiry in order to address how the abuse of older LGBT people intersects with each domain     

Sterile water injections for childbirth pain: An evidenced based guide to practice

Background

About 30% of women in labour suffer from lower back pain. Studies of sterile water injections for management of low back pain have consistently shown this approach to be effective. The objective of this evidence-based guide is to facilitate the clinical use of sterile water injections to relieve lower back pain in labouring women.

Sex differences in psychological distress,behavioural and emotional problems,and substance use in young people in out‐of‐home care

The aim of the study was to examine sex differences in self‐reported psychological distress, behavioural and emotional problems, and substance use in young people living in out‐of‐home care (OoHC). One hundred seventy‐six young people aged 12–17 years (females 53.4%) in OoHC in metropolitan Melbourne, Australia, were interviewed. Participants completed self‐report measures: Kessler Psychological Distress Scale, Strengths and Difficulties Questionnaire, and the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test—Youth Version. Girls had more OoHC placement instability over the past year compared with boys (p = .019). Compared with boys, the girls had significantly higher levels of distress (p < .001) (p = .007), were more likely to have self‐reported emotional symptoms (p < .001) and peer relationship problems (p = .043) and were more likely to use sedatives (p = .004). Girls had more psychological distress, behavioural disturbance, and sedative abuse; placement instability might contribute to these problems. Greater integration across OoHC, mental health, and substance use sectors is required. Girls in OoHC may benefit from interventions targeting problems with peer relationship and substance use and supporting prosocial behaviour; such targets may reduce distress and emotional symptoms and possibly prevent longer term problems.