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Issue 8 - 9 March 2015

Articles – Clinical Pathways

1. Do clinical pathways enhance access to evidence-based acute myocardial infarction treatment in rural emergency departments?
By Kinsman, Leigh D.; Rotter, Thomas; Willis, Jon; Snow, Pamela C.; Buykx, Penny & Humphreys, John S.
Australian Journal of Rural Health. Apr 2012, Vol. 20 Issue 2, p59-66. 8p.
DOI: 10.1111/j.1440-1584.2012.01262.x.
Abstract: Objective
: The objective of this study is to measure the impact of a five-step implementation process for an acute myocardial infarction (AMI) clinical pathway (CPW) on thrombolytic administration in rural emergency departments. Design: Cluster randomised controlled trial. Setting: Six rural Victorian emergency departments participated. Intervention: The five-step CPW implementation process comprised (i) engaging clinicians; (ii) CPW development; (iii) reminders; (iv) education; and (v) audit and feedback. Main outcome measures: The impact of the intervention was assessed by measuring the proportion of eligible AMI patients receiving a thrombolytic and time to thrombolysis and electrocardiogram

2. Role of clinical pathways in health care provision: Focus on cancer treatment
By Kreys, Eugene D. & Koeller, Jim M.
American Journal of Health-System Pharmacy. 6/15/2013, Vol. 70 Issue 12, p1081-1085. 5p. DOI: 10.2146/ajhp120235.
: The article discusses the reduction in medical care costs involving cancer care through the use of clinical pathways, which are structured multidisciplinary care plans designed for specific clinical problem. Studies conducted within various health care settings are cited which demonstrated the pathways have resulted to enhanced economic and public health advantages. The pathways are also adopted by managed care and other health care organizations.

3. Clinical pathways in head injury: improving the quality of care with early rehabilitation
By Singh, Rajiv; Venkateshwara, Guruprasad; Kirkland, John; Batterley, Julie & Bruce, Sarah.
Disability & Rehabilitation. Mar 2012, Vol. 34 Issue 5, p439-442. 4p. 1 Chart.
DOI: 10.3109/09638288.2011.608146.
Abstract: Purpose
: To improve the management of all hospital admissions with head injuries, including mild and moderate by developing a clinical pathway and a head injury team. Methods: A head injury team was set up to take over the care of all admissions with head injury and to manage appropriate referrals and discharges. A key role was to facilitate communication between the different services involved in head injury care, arrange follow-up, support relatives and to educate healthcare staff

4. Work in an intermediate unit: balancing between relational, practical and moral care
By Johannessen, Anne-Kari; Werner, Anne; Steihaug, Sissel.
Journal of Clinical Nursing. Feb 2014, Vol. 23 Issue 3/4, p586-595. 10p. 1 Chart.
DOI: 10.1111/jocn.12213.
Abstract: Aims and objectives:
To explore the activities carried out and the conditions required to enable satisfactory work in an intermediate unit for patients aged 60 and older. Background: In recent years, several intermediate units have been established to improve the clinical pathway from hospital to home for older patients. Design Qualitative study. Methods Data were obtained from interviews with eight patients and 16 healthcare providers working in the unit and from observations in six multidisciplinary meetings and six report meetings in the unit. Transcripts of interviews and field notes were analysed using a method for systematic text condensation.
Results: Care performed as a balance between relational, practical and moral aspects seems to be important to render good service to patients and to ensure the providers' job satisfaction

Selected articles - Journal of Law, Medicine & Ethics

5. Trust and Transparency: Patient Perceptions of Physicians' Financial Relationships with Pharmaceutical Companies
By Perry, Joshua E.; Cox, Dena; Cox, Anthony D.
Journal of Law, Medicine & Ethics. Winter 2014, Vol. 42 Issue 4, p475-491. 17p. 
DOI: 10.1111/jlme.12169.
: Financial ties between physicians and pharmaceutical companies are pervasive and controversial. However, little is known about how patients perceive such ties. This paper describes an experiment examining how a national sample of U.S. adults perceived a variety of financial relationships between physicians and drug companies.

6. Economism and the Commercialization of Health Care
By: Brody, Howard.
Journal of Law, Medicine & Ethics. Winter 2014, Vol. 42 Issue 4, p501-508. 8p.
DOI: 10.1111/jlme.12171.
: Those concerned over the excessive commercialization of health care, to the detriment of both professional and patient-centered values, commonly propose remedies that assume that meaningful change can occur largely within the health care sector. I argue instead that a major shift in the public culture and political discourse of the U.S. will be required if the commercialization of health care is to be adequately addressed. The notion that health and health care are commodities to be bought and sold in the market is encouraged by the ideology that is preferably called economism, though also today labeled neoliberalism, market fundamentalism, market triumphalism, and other terms.

Articles – Moral Distress

7. Researching moral distress among New Zealand nurses: A national survey
By Woods, Martin; Rodgers, Vivien; Towers, Andy; La Grow, Steven.
Nursing Ethics. Feb 2015, Vol. 22 Issue 1, p117-130. 14p. DOI: 10.1177/0969733014542679.
: The article presents a study on the magnitude and level of moral distress among registered nurses (RNs) in New Zealand which suggested the need to be addressed by health service managers, lawmakers and nurse educators. Topics discussed include the factors that contribute to RNs' experience of moral distress such as organisational policies, ethical issues and healthcare cost, its impact on the delivery of quality healthcare, and how it can lead to feelings of frustration, anger and anxiety

8. Moral distress’ – time to abandon a flawed nursing construct?
By Johnstone, Megan-Jane; Hutchinson, Alison.
Nursing Ethics. Feb 2015, Vol. 22 Issue 1, p5-14. 10p. DOI: 10.1177/0969733013505312.
: Moral distress has been characterised in the nursing literature as a major problem affecting nurses in all healthcare systems. It has been portrayed as threatening the integrity of nurses and ultimately the quality of patient care. However, nursing discourse on moral distress is not without controversy. The notion itself is conceptually flawed and suffers from both theoretical and practical difficulties. Nursing research investigating moral distress is also problematic on account of being methodologically weak and disparate.

9. A Framework for Understanding Moral Distress among Palliative Care Clinicians.
By Rushton, Cynda H.; Kaszniak, Alfred W.; Halifax, Joan S.
Journal of Palliative Medicine. Sep 2013, Vol. 16 Issue 9, p1074-1079. 6p. 1 Diagram.
DOI: 10.1089/jpm.2012.0490.
Abstract: Background
: Palliative care clinicians confront suffering as they care for people living with life-limiting conditions. When the degree of suffering becomes unjustified, moral distress can ensue. Promising work from neuroscience and social psychology has yet to be applied to clinical practice.
Objective: Our objective was to expand a social psychology model focusing on empathy and compassion in response to suffering to include an ethical dimension and to examine how the interrelationships of its proposed components can assist clinicians in understanding their responses to morally distressing situations.

10. Moral distress in end-of-life care in the intensive care unit
By St Ledger, Una; Begley, Ann; Reid, Joanne; Prior, Lindsay; McAuley, Danny; Blackwood, Bronagh.
Journal of Advanced Nursing. Aug 2013, Vol. 69 Issue 8, p1869-1880. 12p. 
DOI: 10.1111/jan.12053
Abstract: Aim:
To explore moral distress in relatives doctors and nurses, in end-of-life care decision-making, in the adult intensive care unit.
Background: Many deaths in intensive care involve decisions about withholding and withdrawing therapy, potentially triggering moral distress. Moral distress occurs when individuals feel constrained from acting in accordance with moral choice, or act against moral judgement, generating painful, unresolved emotions, and problems that continue long after an event.

Journal - Table of Contents

Working Life: The PSA Journal

11A. It’s a bargain: Collective bargaining
11B. Advocating for pay equity
11C. Does income inequality hurt economic growth?
11D. Public information and the OIA [In December the chief ombudsman announced a review of the Official Information Act 1982 practices in the public sector]
11E. Analysing the results of the Workplace Dynamics in New Zealand Public Services Survey I[Read the full report here:

11F. UnionAID: Connecting workers, connecting countries [An interview with Michael Naylor about the organisation’s history and its future]
11G. Legal: Employment Relations Act changes – a primer
11H. Health and safety law update
11I. The dating game [Online dating has been around for years, but improving technology – smartphones in particular – has led to a rapid rise in usage, particularly by under 35s..]
11J. Review of the security environment for the Ministry of Social Development
11K. How to go back to work successfully [getting back in the grove after an extended break]


12. The MHS Conference 2015: Translating Best Practice into Reality
25-28 August 2015
Venue: National Convention Centre, Canberra ACT Australia
More information:

13. The 2nd Annual Australian & New Zealand Eating Disorders and Obesity Conference
: May 18-19, 2015
Venue: Outrigger, Surfers Paradise
More information:

14. Stroke rehabilitation conference
: 10th - 12th May 2015
More information:

15. Living in the fullness of life: mental Health - dementia – 2015 Conference
New Zealand faith Community Nurses Association
: Saturday 12 September 2015
Venue: St Christopher’s Anglican Church, Warren Hall,
244 Avonhead Road, Avonhead, CHRISTCHURCH
More information:

16. Home and Community Health Association Conference 2015
Date: 28–30 April 2015
Venue: Rendezvous Grand Hotel, Auckland
The Home and Community Health Association (HCHA) Conference 2015 will explore the challenges and opportunities of changes occurring in home and community services as a result of consumer and cultural needs; demographics and choices; and strategy around workforce, community supports and integration

News – National

17. Private health insurance - An expanding role in the future of health care?
A report for the Health Funds Association of New Zealand.
09 March 2015
By Derek Gill and Michael Bealing
Download the full report here:

18. A $20 gadget that can save 70,000 mothers a year
New Zealand Herald - Monday Mar 9, 2015
The lives of tens of thousands of new mothers around the world could be saved by a simple, hand-held, British-made device costing only £12, which runs on a mobile-phone charger and is set to be introduced in hospitals across Africa, India and Pakistan.

News – international

19. Official NHS calculator predicts when you will have a heart attack
The NHS has launched a controversial calculator which predicts when you will have a heart attack or stroke - and compares a person’s “heart age” with their biological age. Health experts said the online tool would give individuals “a wake-up call” - pushing those at risk of heart disease into making lifestyle changes to protect themselves from the UK’s biggest killer
The Telegraph – 8 March 2015

20. Opinion - New study: Anti-vaccination views dominate on open platforms online
LA Times – March 3, 2015
The authors -- Dr. Anand Venkatraman at the University of Alabama, Birmingham, Dr Nilay Kumar at Cambridge Health Alliance and Dr Neetika Garg at Beth Israel Deaconess Medical Center -- scoured YouTube, Google, Wikipedia and PubMed to see if there was any correlation between the ability to upload content and the prevalence of items linking vaccinations and autism.

21. The health risks of cyberbullying in college
Sandee LaMotte, Special to CNN

Updated 1906 GMT (0306 HKT) March 3, 2015
What about college students? After all, they're the most frequent users of digital technology and social media sites. Will their increased maturity and experience keep them safe? Not so much, according to a new study from the University of Washington. Questioning 265 girls enrolled in four colleges, researchers found college-age females just as likely to suffer the negative effects of cyberbullying as younger adolescents

22. Ageism in the workplace hurts us all
The Age - March 3, 2015 
I suspect if you were to ask many of those in their late 40s and older if ageism could hold Australia back, their answer would be "yes". That disappointing view would invariably be based on their personal experiences in the workforce.  Ageism will hold us back because, with an ageing population, we need to increase participation by older  workers in the workforce. The evidence over recent decades indicates older people are underemployed for longer periods than younger workers. To safeguard our way of life, we must keep people in jobs and the economy growing.

23. Living alone is linked to social advantage in young women but disadvantage in middle-aged men
Sydney Morning Herald - March 3, 2015
Living alone gets a bad rap. Often seen as an expensive exercise in social isolation, it can conjure up images of loneliness, toast for dinner and too many cats.  But a quarter of Australian homes are now "lone-person" households, and new research shows the experience of living alone depends very much on a number of factors, including your gender, education, income and age.

24. 5 vaccine jabs at once? Kids' parents increasingly seek delays and doctors sometimes agree
Calgary Herald – 1 Mar 2015
CHICAGO - Parents have increasingly pressured doctors to delay vaccines for young children, making their kids and others vulnerable to preventable diseases, a study suggests. The findings are in a national survey of pediatricians and family doctors asked about parents wanting to postpone some of the many shots recommended for children younger than age 2. Nearly all doctors said that at least some parents had requested vaccine delays in a typical month; and 1 in 4 said those numbers had increased since the previous year.


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