Validating quality indicators. Quality as relationship between structure, process, and outcome

Theory and research have not kept pace with the growing interest in evaluating quality of mental health care, resulting in the use of unvalidated quality indicators. A framework for validating quality indicators is offered by which quality is viewed as the relationship between service structures, processes, and outcomes. Adoption of this framework will facilitate the measurement of quality using valid indicators and should be useful to agencies in their continuous quality improvement efforts. Valid information about the quality of mental health care services will help purchasers and consumers make more informed health care decisions.     

NDIS Self‐Management Approaches: Opportunities for choice and control or an Uber‐style wild west?

This article examines the emerging challenges and opportunities presented by self‐management options in Australia's National Disability Insurance Scheme (NDIS). We examine the three different ways in which NDIS participants can opt to self‐manage their funding and services, including direct employment and emerging Uber‐style online platforms, and explore the potential implications of these options for NDIS participants, service providers and the disability support workforce. In particular, we focus on these options in relation to the transition to a marketised services landscape being developed alongside the NDIS, and examine both the risks and opportunities for each stakeholder group. Through this analysis, we identify implications for policy and practice, in particular around regulatory mechanisms and the role of government within this emerging market economy and transforming service landscape.     

Nurse safety: How is safety climate related to affect and attitude?

Occupational accidents and injuries continue to be a critical concern for nurses, given the hazardous healthcare environment. This study advances the research on workplace safety by studying the process variables (i.e. job-related negative affect (JRNA) and job satisfaction) in explaining the relationship between safety climate and various safety criteria in nurses. Based on survey data from 326 nurses, our findings suggest that psychological safety climate is negatively related to JRNA, turnover intentions, safety workarounds, and workplace hazards. In addition, structural equation modelling indicated general support for a model in which psychological safety climate influences employee strain through job attitudes, including JRNA and job satisfaction. More specifically, job attitudes were found to mediate the relationship between psychological safety climate and turnover intentions, experience of hazards, and injuries. Safety workarounds did not significantly relate to injuries. The present study contributes to the ongoing improvement of interventions aimed at mitigating nurses’ injuries by integrating job attitudes into the safety climate–safety outcome framework.     

A big hole with the wind blowing through it: Aboriginal women's experiences of trauma and problem gambling

Although studies have shown a link between social trauma and problem gambling (PG), there is little research involving Aboriginal women in this area, despite Aboriginal women being potentially at higher risk for both social trauma and problem gambling. This article describes the results of a qualitative phenomenology study asking seven Aboriginal women living in Western Canada to describe their experiences of social trauma and gambling problems. Results suggest four main themes, describing: (1) the Aboriginal women's experiences of social trauma (‘the three tigers’); (2) their use of gambling to cope with these experiences (‘a big hole with the wind blowing through it’); (3) their experience of problem gambling (‘I'm somebody today’); and (4) their process of healing from social trauma and gambling problems (‘a letter to John’). Participants described what they felt was a clear link between social trauma and problems with gambling, and how gambling helped to change their mood and block out the past. The results raise the possibility that Aboriginal women with gambling problems may need support to heal from social trauma – including racism and colonization – and that upstream initiatives to reduce the incidence of social traumas may be an important response to problem gambling among Aboriginal women.