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The aim of this article is to explore organisational recruitment practices from human resources (HR) experts’ narratives and discuss the challenges of recruiting underrepresented groups in relation to these practices. From the HR experts’ narratives, we identify four organisational recruitment practices: the informal, the pragmatic, the standardised and the strategic. These practices consist of, for example, ‘subjective’ judgements versus ‘objective’ criteria and are construed in relation to different rationalities, which also give rise to various dilemmas in relation to underrepresented groups. From our analysis, there seems to be a paradox between enhancing diversity and counteracting discrimination. Organisational recruitment practices that are counteracting discrimination do not necessarily enhance diversity and recruitment practices that radically work with enhancing diversity can be seen as discriminatory. We thereby draw the conclusion that there is no effective practice for the recruitment of underrepresented groups in the labour market. This is a dilemma for HR experts and a challenge for the Swedish labour market in general.

AIMS AND OBJECTIVES: To examine underlying factor structure of the Critical Care Family Needs Inventory-Emergency Department across three countries to identify similarities and differences. BACKGROUND: Understanding family needs assists nurses to provide family-centred care to deliver optimal outcomes for critically ill patients and their families in Emergency Departments. DESIGN: Retrospective secondary analyses of data collected in three cross-sectional surveys. METHOD(S): Convenience samples involved recruitment of family members accompanying a critically ill relative into four Emergency Departments in Australia (2), South Africa (1) and Taiwan (1). Item-matched raw data from 374 responses to 40 items from the surveys were collated and analysed using confirmatory factor analysis methods. Reporting adhered to an adapted STROBE checklist. RESULT(S): The factor structure of the 40-item Critical Care Family Needs Inventory-Emergency Department differed between countries. Analyses of the Australian data revealed a four-factor solution comprised of 18 items across four categories of family need (support, communication, participation and comfort); the Taiwanese data also demonstrated a four-factor solution comprised of 13 items (support, communication, participation and comfort); alternatively, the South African data revealed a two-factor solution comprised of nine items (communication and participation). Fifteen items did not match across the countries. However, loading for four items common across all three countries was related to family participation (3) and communication (1). CONCLUSION(S): The findings suggest family members from different countries responded to Critical Care Family Needs Inventory-Emergency Department items in different ways. Consistent with concepts of family-centred care, the study identified participation and communication needs that were common across the countries. The outcomes illustrate the challenge of providing appropriate care for famil

OBJECTIVES: This study explores the influences of the paediatric intensive care environment on relationships between parents and healthcare providers when children are dying. It forms part of a larger study, investigating parental experiences of the death of their child in intensive care. RESEARCH METHODOLOGY: Constructivist grounded theory. SETTING: Four Australian paediatric intensive care units. MAIN OUTCOME MEASURES: Audio-recorded, semi-structured interviews were conducted with twenty-six bereaved parents. Data were analysed using the constant comparison and memoing techniques common to grounded theory. FINDINGS: The physical and social environment of the intensive care unit influenced the quality of the parent-healthcare provider relationship. When a welcoming, open environment existed, parents tended to feel respected as equal and included members of their child's care team. In contrast, environments that restricted parental presence or lacked resources for parental self-care could leave parents feeling like 'watchers', excluded from their child's care. CONCLUSION(S): The paediatric intensive care unit environment either welcomes and includes parents of dying children into the care team, or demotes them to the status of 'watcher'. Such environments significantly influence the relationships parents form with healthcare staff, their ability to engage in elements of their parental role, and their experiences as a whole.Copyright © 2017 Elsevier Ltd. All rights reserved.

Conducting qualitative research, especially in areas considered 'sensitive', presents many challenges. The processes involved in such research often expose both participants and the research team to a vast array of risks, which may cause damage to their personal, professional, social and cultural worlds. Historically, these risks have been considered independent of each other, with most studies exploring only the risks to participants or only risks to researchers. Additionally, most researchers only consider risks during data collection, frequently overlooking risks that might be present during other phases of the research project. We aim, therefore, to bring together this fractured literature to enable an integrated exploration of the current academic discourse relating to risks to participants with the literature exploring risks to researchers across all phases of the research process. This article draws on personal experiences to highlight ethical issues and risks encountered by both participants and researchers throughout all phases of a research project. Beginning in recruitment, we discuss the risk of secondary distress in participants arising from researcher contact and then explore the concept of informed consent during grief and bereavement research. We then focus on risks present during data collection, examining risks for participants, such as emotional distress, and potential safety risks for the research team. Finally, we consider the risks which arise in data analysis, including both confidentiality and the possibility of researcher burnout. Previous recommendations are summarised, with new management strategies suggested based on lessons learned along the way.

BACKGROUND: It is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implementation could involve disseminating evidence-based policy recommendations, along with the use of knowledge brokers. We developed such a model to aid decision-making for the provision of weekend allied health services. This protocol outlines the design and methods for a multi-centre cluster randomised controlled trial to evaluate the success of research implementation strategies to promote evidence-informed weekend allied health resource allocation decisions, especially in hospital managers. METHOD(S): This multi-centre study will be a three-group parallel cluster randomised controlled trial. Allied health managers from Australian and New Zealand hospitals will be randomised to receive either (1) an evidence-based policy recommendation document to guide weekend allied health resource allocation decisions, (2) the same policy recommendation document with support from a knowledge broker to help implement weekend allied health policy recommendations, or (3) a usual practice control group. The primary outcome will be alignment of weekend allied health service provision with policy recommendations. This will be measured by the number of allied health service events (occasions of service) occurring on weekends as a proportion of total allied health service events for the relevant hospital wards at baseline and 12-month follow-up. DISCUSSION: Evidence-based policy recommendation documents communicate key research findings in an accessible format. This comparatively low-cost research implementation strategy could be combined with using a knowledge broker to work collaboratively with decision-makers to promote knowledge transfer. The

INTRODUCTION: There is a growing body of evidence to indicate that both primary and subsequent caesarean sections are associated with increased maternal and perinatal morbidity. Efforts to reduce the number of clinically unnecessary caesarean sections are urgently required. Our objective is to systematically review published evidence on the effectiveness of maternity service organisational interventions, such as models of maternity care, that aim to reduce caesarean section rates. METHODS AND ANALYSIS: Databases will be searched, including the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS. Search terms related to caesarean section and organisational intervention will be used. Research published before 1980 will be excluded and only randomised controlled trials, cluster-randomised controlled trials, quasi-randomised controlled trials, controlled before and after studies and interrupted time series studies will be included. Data extraction and quality assessments will be undertaken by two authors. ETHICS AND DISSEMINATION: Ethics approval is not required for this systematic review. The results of this study will be disseminated via peer-reviewed publication and presentation at professional conferences. PROSPERO REGISTRATION NUMBER: CRD42016039458.Copyright © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Clinicians who teach are essential for the health workforce but require faculty development to improve their educational skills. Curricula for faculty development programs are often based on expert frameworks without consideration of the learning priorities as defined by clinical supervisors themselves. We sought to inform these curricula by highlighting clinical supervisors own requirements through answering the research question: what do clinical supervisors identify as relative strengths and areas for improvement in their teaching practice? This mixed methods study employed a modified version of the Maastricht Clinical Teaching Questionnaire (mMCTQ) which included free-text reflections. Descriptive statistics were calculated and content analysis was conducted on textual comments. 481 (49%) of 978 clinical supervisors submitted their mMCTQs and associated reflections for the research study. Clinical supervisors self-identified relatively strong capability with interpersonal skills or attributes and indicated least capability with assisting learners to explore strengths, weaknesses and learning goals. The qualitative category 'establishing relationships' was the most reported strength with 224 responses. The qualitative category 'feedback' was the most reported area for improvement, with 151 responses. Key areas for curricular focus include: improving feedback practices; stimulating reflective and agentic learning; and managing the logistics of a clinical education environment. Clinical supervisors' self-identified needs provide a foundation for designing engaging and relevant faculty development programs.

BACKGROUND: Research exploring nurses' experiences working with families in paediatric intensive care unit (PICU) is limited. No studies have been undertaken in a mixed adult-paediatric ICU. OBJECTIVE(S): To explore nurses' perceptions of working with families of critically ill children in a mixed adult-paediatric intensive care unit (ICU). DESIGN: Descriptive qualitative design. METHODOLOGY: Five PICU nurses participated in semi-structured interviews. Data were analysed using thematic analysis. Trustworthiness was enhanced using an audit trail, member checks and peer review of all data. RESULT(S): Three main themes and one overarching theme emerged. Role confusion and delineation examined the roles which nurses ascribed to themselves and the families; and demonstrated the conflict which could arise if roles were challenged. Information sharing demonstrated the positive and negative ways in which nurses utilized information with families in their daily practice. The contextual environment of the PICU scrutinized the physical, cultural and institutional factors which impacted on the nurses' ability to work with families in the PICU. Finally, the overarching theme Competing values explores the interplay between the nurses' personal values and those of the PICU and the institution. CONCLUSION(S): Working with families in a mixed adult-paediatric ICU is influenced by multiple personal and institutional factors. The value placed on families and on the time nurses spent with them often competed for priority with nurses' other values and the wider culture of the PICU. The potential for role confusion, the management of information and the physical environment of the PICU further contributed to variability in nurses' working with families. RELEVANCE TO CLINICAL PRACTICE: The results highlighted a need for education for both nurses and medical staff who work with families of critically ill children. Additionally, the need for each PICU to have a written policy on family pres

BACKGROUND: Organizational context is one factor influencing the translation of evidence into practice, but data pertaining to patients with acute stroke are limited. We aimed to determine the associations of organizational context in relation to four important evidence-based stroke care processes. METHOD(S): This was a mixed methods cross-sectional study. Among 19 hospitals in Queensland, Australia, a survey was conducted of the perceptions of stroke clinicians about their work using the Alberta Context Tool (ACT), a validated measure covering 10 concepts of organizational context, and with additional stroke-specific contextual questions. These data were linked to the Australian Stroke Clinical Registry (AuSCR) to determine the relationship with receipt of evidence-based acute stroke care (acute stroke unit admission, use of thrombolysis for those with acute ischemic stroke, receipt of a written care plan on discharge, and prescription of antihypertensive medications on discharge) using quantile regression. Exploratory cluster analysis was used to categorize hospitals into high and low context groups based on all of the 10 ACT concepts. Differences in adherence to care processes between the two groups were examined. RESULT(S): A total of 215 clinicians completed the survey (50% nurses, 37% allied health staff, 10% medical practitioners), with 81% being in their current role for at least 1year. There was good reliability ( 0.83) within the cohort to allow pooling of professional groups. Greater ACT scores, especially for social capital (mu 9.00, 95% confidence interval [CI] 4.86 to 13.14) and culture (mu 7.33, 95% CI 2.05 to 12.62), were associated with more patients receiving stroke unit care. There was no correlation between ACT concepts and other care processes. Working within higher compared to lower context environments was associated with greater proportions of patients receiving stroke unit care (88.5% vs. 69.0%) and being prescribed antihypertensive medicati

AIMS AND OBJECTIVES: (a) Describe the co-development of a point-of-care App to promote uptake of best practice recommendations and consolidate nurses' knowledge for managing symptoms of neurocognitive disorders. (b) Report acceptability, usability and feasibility of the App to nurses for patient care in hospital. BACKGROUND: Strategies used in hospitals to reduce symptoms, risk of harm, or complications of behavioural and psychological symptoms associated with neurocognitive disorders are frequently inconsistent with best practice recommendations. DESIGN: Three-stage, mixed-methods, process and outcome evaluation. METHOD(S): The App was co-developed with experts, nurse end-users and a consumer. Evaluation data were collected from a convenience sample of nurses observed during delivery of 80.5 hr of care to 38 patients; the App (n = 32 patients); and individual and focus group interviews with nurses (n = 25). Reporting adhered to an adapted STROBE checklist. RESULT(S): The App included three components: cognition and risk assessment; tailored evidence-based strategies; and monitoring and evaluation of effectiveness. Observation data captured nurses using the App with 44.7% (n = 17) of eligible inpatients. Cognitive screening was completed at least once for each patient, with 146 risk assessments recorded. Interview data indicated the App's acceptability was enhanced by familiarity and perceived benefits, but hindered by perceived increases in workload, inconsistent use, pressure to use the App and resistance to change. Feasibility and usability were enhanced by easy navigation, and clear and useful content, but hindered by unclear expectations, unfamiliarity and device-related factors. CONCLUSION(S): The App provided an evidence-based tool that was, overall, considered feasible and acceptable to support best practice. Findings provide guidance to enhance usability for future implementation. RELEVANCE TO CLINICAL PRACTICE: Co-development using best evidence and key st

BACKGROUND:: Patients with dementia may receive suboptimal end-of-life care in hospital settings reflecting broader debate around the palliative status of dementia syndromes. OBJECTIVE(S):: To synthesize literature describing the quality of end-of-life care for patients with dementia dying in hospital. METHOD(S):: An integrative review assessed the quality of 26 articles concerning medical, nursing, and psychosocial care of patients with dementia dying in hospital settings. RESULT(S):: Literature reflects a growing awareness of the need to consider a palliative approach to end-of-life care for patients with dementia in hospital. Patients with dementia are less likely to receive aggressive care at the end of life, but provision of palliative care interventions is inconsistent. Health-care professionals highlighted the need for greater education around identification and management of problematic symptoms at the end of life. Engagement of family caregivers is essential in optimizing end-of-life care, and further research is required to ascertain their experiences around decision-making. CONCLUSION(S):: Although patients with dementia appear to receive less aggressive treatment at the end of life, the provision of palliative care and symptom management may be inadequate.

This chapter sets the scene for this volume on Critical Perspectives on the Management and Organization of Emergency Services, as part of the Routledge Critical Studies in Public Management Series. It establishes the context and background for the book and highlights a lack of critical understanding about the nature and work of the emergency services. This introduction discusses the contested nature of policy making in these vital services, the theory-practice divide and what we mean by ‘critical’ when applied to management and organisation studies research. The aims of the book and the organisation of the chapters including short summaries of each are outlined below and the chapter ends with a call for further research into the organization and management of the emergency services.

A conceptual schematization is presented, taken as the basis to understand how the social construction of the territory is generated from the management of the conflicts that develop in it, from the planning for development and a case study carried out in the Central Pacific of Costa Rica, depending on the management of a responsible marine fishing area in the communities called Paquera and Tambor in the Nicoya Peninsula. The sea as a territory starts from a social construction of space, from the various interrelationships between actors, but also has as a basis a correlation of weights and counterweights that manage the organizational processes that take place there. Based on the interactions between the various actors in the territory, transformations are generated that have implications in the development and planning processes, linked to institutional management., É apresentada uma esquematização conceitual, tomada como base para a compreensão de como a construção social do território é gerada a partir da gestão dos conflitos que nele se desenvolvem, do planejamento para o desenvolvimento e do estudo de caso realizadono Pacífico Central da Costa Rica. . , dependendo da gestão de uma área de pesca marinha responsável nas comunidades chamada Flirting and Drum na Península de Nicoya. O mar como território parte de uma construção social do espaço, das várias inter-relações entre atores, mas também tem como base uma correlação de pesos e contrapesos que gerenciam os processos organizacionais que ali ocorrem. A partir das interações entre os diversos atores do território, são geradas transformações que têm implicações nos processos de desenvolvimento e planejamento, vinculadas à gestão institucional., Se expone una esquematización conceptual, tomada como base para comprender como se genera la construcción social del territorio desde la gestión de las conflictividades que se desarrollan en este, a partir de la planificación para el desarrollo y un caso de estudio ejecutado en el Pacífico Central de Costa Rica, en función de la gestión de un área marina de pesca Responsable en las comunidades denominadas Paquera y Tambor en la Península de Nicoya. El mar como territorio parte desde una construcción social del espacio, de las diversas interrelaciones entre actores, pero además tiene como base una correlación de fuerzas de pesos y contrapesos que gestionan los procesos organizativos que ahí se desarrollan. Con base a las interacciones entre los diversos actores en el territorio se generan transformaciones que tienen implicaciones en los procesos de desarrollo y de planificación, vinculadas con la gestión institucional.

The objective of the present paper is to elucidate the practices performed by farming cooperatives regarding the tax, accounting and administrative management linked to the Tax Incentive for Innovation (TII). In this sense, the relation between the tax regime of cooperatives and access to TII was investigated. For a better understanding of this, a research of qualitative nature, whose investigation method was the single case study, was performed, in which the analysis unit was a Brazilian Agroindustry Cooperatives Central. Such Central comprehends a group of 30 agroindustry cooperatives and has the largest industrial park of powdered milk in Latin America. Besides that, such organization houses Research & Development (R&D) department. As a result, it was inferred that the policies that regiment the incentive for innovation confront the nature of cooperatives, decreasing the capacity such organizations have in the appropriation of this policy. Thus, there is a reducer factor in the participation of cooperatives in TII. Hence, it is suggested a debate involving the diverse actors in the innovation system, in which cooperatives are involved, to decide if such reducer factor must be overcome or accepted. Finally, the tax, accounting and administrative management that routinely operates in the Central was able to respond to the new specific procedures related to the use of the policy in debate, without the implementation of new processes., O objetivo deste artigo é elucidar as práticas realizadas pelas cooperativas agropecuárias quanto à gestão tributária, contábil e gerencial vinculada ao Incentivo Fiscal à Inovação (IFI). Nesse sentido, investigou-se a relação entre o regime tributário das cooperativas e o acesso ao IFI. Para entender isso melhor, realizou-se uma pesquisa de natureza qualitativa cujo método de investigação selecionado foi o de estudo de caso único, sendo a unidade de análise uma Central de Cooperativas Agroindustriais brasileira. Tal Central congrega um conjunto de 30 cooperativas agroindustriais e possui o maior parque industrial de leite em pó da América Latina. Além disso, tal organização aloja um departamento de Pesquisa e Desenvolvimento (P&D). Como resultado, inferiu-se que os dispositivos que normatizam o incentivo à inovação se confrontam com a natureza das cooperativas, diminuindo a capacidade que essas organizações possuem para se apropriar dessa política. Assim, existe um fator redutor da participação das cooperativas no IFI. Com isso, sugere-se um debate envolvendo diversos atores do sistema de inovação no qual as cooperativas estão envolvidas para decidir se tal fator redutor deve ser superado ou aceito. Por fim, a gestão contábil, administrativa e gerencial, que já era rotineiramente operacionalizada na Central, foi capaz de atender aos novos procedimentos específicos relacionados à utilização da política em debate, sem a implementação de novos processos.

Background.: Occupational therapists support everyday technology use; however, it is necessary to consider the challenges that people with dementia encounter with everyday technologies when participating in various places within public space. Purpose.: The purpose of the study was to explore stability and change in participation in places visited within public space in relation to the relevance of everyday technologies used within public space. Method.: People with dementia (n = 35) and people with no known cognitive impairment (n = 34) were interviewed using the Participation in Activities and Places Outside Home Questionnaire and the Everyday Technology Use Questionnaire. Data analysis used modern and classical test theory. Findings.: Both samples participated in places within public space; however, participation and relevance of everyday technologies were significantly lower for the dementia group. Implications.: To enable participation, occupational therapists need to be aware of challenges that technologies and places within public space present to people with dementia.

Tourists are particularly vulnerable when natural disasters occur in regions that they are visiting. It is assumed that they lack awareness and understanding of the actions that they need to take in such circumstances. This study examines the responses of tourists in times of disaster, building on empirical data collected through large‐scale surveys conducted in Bali and Yogyakarta, Indonesia, in 2015. Both are important tourist destinations in the country that have suffered major disasters in recent years. The different types of responses to these events are framed using a grid/group analysis stemming from cultural theory. The study resulted in three key findings: (i) current disaster management planning largely follows a single rationale; (ii) tourists are not a homogeneous group, but rather a complex, diverse, and dynamic body of stakeholders; and (iii) the focus of disaster management planning should shift from a single rationale to a polyrational methodology. Disaster managers need to consider, therefore, these different aspects in the context of preparedness.

BACKGROUND: This is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment. RESULTS: Four literature reviews were completed, surveys were received from 15 external experts, 65 interviews were conducted, 18 senior decision-makers attended a data gathering workshop, 22 experts and local informants were consulted, and four decision-making workshops were undertaken. Mechanisms to identify disinvestment targets and criteria for prioritisation and decision-making were investigated. A catalogue containing 184 evidence-based opportunities for disinvestment and an algorithm to identify disinvestment projects were developed. An Expression of Interest process identified two potential disinvestment projects. Seventeen additional projects were proposed through a non-systematic nomination process. Four of the 19 proposals were selected as pilot projects but only one reached the implementation stage. Factors with potential influence on the outcomes of disinvestment projects are discussed and barriers and enablers in the pilot projects are summarised. CONCLUSION: This study provides an in-depth insight into the experience of disinvestment in one local healthcare service. To our knowledge, this is the first paper to report the process of disinvestment from identification, through prioritisation and decision-making, to implementation and evaluation, and finally explication of the processes and outcomes. METHODS: Literature reviews, survey, interviews, consultation and workshops were

BACKGROUND: It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors. METHODS: An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data. RESULTS: After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarcha

DESIGN AND METHODS: Constructivist grounded theory was used to undertake this study. Semi-structured interviewers were conducted with 26 bereaved parents recruited from four Australian pediatric intensive care units. The constant comparative method, coupled with open, focused, and theoretical coding were used for data analysis. RESULTS: Becoming a team explores the changes that occurred to the parent-healthcare provider relationship when parents realized their child was dying and attempted to become part of their child's care team. When the focus of care changed from 'life-saving' to 'end-of-life', parents' perspectives and desires of their and the healthcare providers' roles changed. Parents' attempted to reconstruct their roles to match their changing perspectives, which may or may not have been successful, depending on their ability to successfully negotiate these roles with healthcare providers. CONCLUSIONS: Findings offer insights into parental understandings of both the parental and healthcare provider roles for parents of dying children in intensive care, and the ways in which the parent-healthcare provider relationships can influence and be influenced by changes to these roles. PRACTICE IMPLICATIONS: Successful parent-healthcare provider relationships require an understanding of the parental and healthcare provider role from the parents' perspective. The meanings of the parental and healthcare provider roles should be explored with parents of dying children, and supported as much as possible to enable the development of a collaborative relationship. PURPOSE: To explore bereaved parents' perspectives of parent and staff roles in the pediatric intensive care unit when their child was dying, and their relationships with healthcare staff during this time.Copyright © 2018 Elsevier Inc. All rights reserved.

BACKGROUND: Falls remain common for community-dwelling older people and impose a substantial economic burden to the healthcare system. RESPOND is a novel falls prevention programme that aims to reduce secondary falls and fall injuries among older people who present to a hospital emergency department (ED) with a fall. The present protocol describes a prospective economic evaluation examining the incremental cost-effectiveness of the RESPOND programme, compared with usual care practice, from the Australian health system perspective. METHODS AND DESIGN: This economic evaluation will recruit 528 participants from two major tertiary hospital EDs in Australia and will be undertaken alongside a multisite randomised controlled trial. Outcome and costing data will be collected for all participants over the 12-month trial. It will compare the RESPOND falls prevention programme with usual care practice (current community-based falls prevention practices) to determine its incremental cost-effectiveness according to three intermediate clinical outcomes: (1) falls prevented, (2) fall injuries prevented and (3) injurious falls prevented. In addition, utilities will be derived from a generic quality-of-life measure (EQ-5D-5L) and used to calculate the 'incremental cost per quality-adjusted life years gained'. DISCUSSION: The results of this study will provide healthcare decision makers with evidence to assist with setting spending thresholds for preventive health programmes and inform selection of emergency and community service models of care. TRIAL REGISTRATION NUMBER: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684); Pre-results.Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

In Australia, nurses performing endoscopic procedures is a recent phenomenon and is uncommon. Challenges include gastroenterologist and patient acceptance of the nurse endoscopist role. This article aims to explore Monash Health's experience with the introduction of a nurse endoscopist. A nurse endoscopist trainee undertook a comprehensive training program under the supervision of a gastroenterologist. All procedural data were collected, organizational policy and procedures were developed, and patients (n = 40) completed a telephone interview postprocedure. The nurse endoscopist trainee completed all training requirements during the 12-month program and was deemed competent for independent practice. The trainee performed 255 colonoscopies, with no complications reported. The organization successfully implemented the expanded scope of practice, established a new model of care for patients, and initiated a governance framework for this advanced practice role. Eighty percent of patients (n = 32) reported that overall, they had a very good experience with the nurse endoscopist trainee. A nurse endoscopist initiative can facilitate the expansion of endoscopy services to meet the growing need for gastroenterological procedures within the community. This pilot program has demonstrated that it is possible to integrate an advanced practice nurse role into an established endoscopy unit.

BACKGROUND: This is the ninth in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The disinvestment literature has broadened considerably over the past decade; however there is a significant gap regarding systematic, integrated, organisation-wide approaches. This debate paper presents a discussion of the conceptual aspects of disinvestment from the local perspective. DISCUSSION: Four themes are discussed: Terminology and concepts, Motivation and purpose, Relationships with other healthcare improvement paradigms, and Challenges to disinvestment. There are multiple definitions for disinvestment, multiple concepts underpin the definitions and multiple alternative terms convey these concepts; some definitions overlap and some are mutually exclusive; and there are systematic discrepancies in use between the research and practice settings. Many authors suggest that the term 'disinvestment' should be avoided due to perceived negative connotations and propose that the concept be considered alongside investment in the context of all resource allocation decisions and approached from the perspective of optimising health care. This may provide motivation for change, reduce disincentives and avoid some of the ethical dilemmas inherent in other disinvestment approaches. The impetus and rationale for disinvestment activities are likely to affect all aspects of the process from identification and prioritisation through to implementation and evaluation but have not been widely discussed. A need for mechanisms, frameworks, methods and tools for disinvestment is reported. However there are several health improvement paradigms with mature frameworks and validated methods and tools that are widely-used and well-accepted in local health services that already undertake disinvestment-type activities and could be expanded and built upon. The nature of disinvestment brings some particular challe

INTRODUCTION: The 2014 Ebola Virus Disease outbreak in West Africa triggered a public health emergency of international concern. Emergency departments worldwide responded with Ebola containment and preparation measures. This paper reports a literature inquiry into how emergency departments and emergency nurses prepared to manage the Ebola risk. METHOD: Narrative review was the method used. Guidelines (n=5) for organisational and emergency department preparedness were retrieved from relevant websites. Searches for primary studies and case reports were undertaken in the MEDLINE and CINAHL databases. After screening and quality appraisal, 20 papers were included in the review. RESULTS: Research and case reports identified 17 different preparedness strategies, and practical interventions for containment undertaken in emergency departments. These included a requirement for surveillance and reporting, Ebola case management, inventory and logistic management, laboratory management, and communication and education. Emergency nurses' personal preparedness was influenced by the emotional readiness, their willingness to care for people at risk of Ebola, and the provision of psychological support. CONCLUSIONS: The preparation efforts reported internationally were generally consistent in strategy and intervention. The findings provide guidance for future preparedness strategies by emergency departments in response to threats like Ebola.Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.