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First, to identify which aspects of missed care accurately define the integration of care and context of care dimensions of the Fundamentals of Care Framework. Second, to test the Framework for validity and reliability and lastly, to explore how leadership influences care integration.A non-experimental research design using self-audit data collected information about variations in nursing care as exemplars for dimensions of the Framework.A multi-variate approach using path analysis was used to apply the consensus scores of 3079 Australian residential care nurses and carers to define the dimensions of the Framework.In the Australian residential care setting, the factors that define both the contexts of care and the integration of care dimensions constructs are now empirically established. The most direct predictor for the integration of care dimension arises from both the leadership and resource allocation variables, while the remaining context of care factors have indirect but significant effects. The integration of psychosocial care in the residential care sector is not influenced by any of the Framework's context-based factors.The component variables of the Framework show both good reliability and convergent validity. These findings confirm a predictive relationship exists between the elements of the context of care and the different types of nursing activities that form the integration of the care dimension, including organizational leadership.

This study quantifies the types and frequencies of missed care identified by nurses and measures its impact on their capacity to demonstrate mandatory practice standards as future hospital staff.Considerable literature exists as to the nature of missed care but there is a paucity of findings about how missed care impacts on learning firstly as a student and then as a graduate nurse employed in a hospital setting. Additionally, there is little emphasis as to how staff development for nurses exposed to missed care may be implemented.A non-experimental research design using self-audit data was selected to collect information about the types and frequencies of missed care from nurses engaging in clinical experience. A convenience sample of 471 nursing students completing their undergraduate nursing degree programme was explored. A multi-variate statistical approach was used to apply and then model the consensus scores of undergraduate nurses' beliefs about the frequency of missed care. Implications for their developing competence in critical thinking, therapeutic communication and maintaining capacity for professional practice has been considered.Eight variables directly affect student's total scores underpinning their understanding of missed care and their ability to meet professional standards of practice, given their exposure to care omission. These factors reflect differing nurse attributes, the nature of the clinical venues and shift times, preceptor type, student satisfaction with work teams and staffing adequacy.Modelling outcomes suggest possible changes to hospital staff development learning programme content, learning processes and how it may be better delivered through to minimize episodes of missed care.Staff development needs to note that nursing staff believe missed care occurs across all three-patient acuity domains with patient observation, education, support, and timely medication administration being most frequently omitted. Different clinical venues within the hospital sector and shift times vary in nurses' exposure with missed care. Student nurses' learning and associated development of practice standards is impacted by prior exposure to missed care during clinical placement. Non-native English-speaking nurses require greatest learning support in the presence of missed care. As missed care can be predicted, remedial changes to the nurse staff development program content and learning processes can be orchestrated.

Background and PurposeOnly a limited number of items involved in missed nursing care inventories specifically focused on infection control practices. The study aimed to adapt and evaluate psychometric properties of the Czech and Slovak version of the Infection Control Missed Care survey; and to assess and compare the amount, type,and reasons for missed nursing care in infection prevention and control amongCzech and Slovak nurses.MethodsThe convenience sample of 1459 nurses from the Czechand Slovak republic was recruited. Analysis of the nurses’ responses to both subscales of the surveys and validation of their data was undertaken using the item response theory (Rasch scaling).ResultsThe now-modified Czech version consists only of 20 items measuring the type and frequency of missed care and 11 items focusing on the reasons for missed care. The now modified Slovak version consists of 34 items measuring the type and frequency of missed care and 17 items measuring the reasons for missed care. Reliability estimates with the removal of unreliable items showed acceptable reliability estimates for both sub-scales of the instrument.ConclusionsWith modification to the two subscales used in the survey (removal of poorly fitting items) it should be reliable, and the resulting data could be used for further investigation such as factor analysis or modelling. The modified Infection Control Missed Care survey could be useful in further research investigating a relationship between nurse staffing, skill mix, and infection control outcomes in acute care hospitals.

Aim This study aimed to quantify types and frequencies of missed infection control care and to develop a theoretical model for estimating nurses' consensus scores about this form of missed care. Design A non-experimental research design using self-audit data was selected to collect information about the types and frequencies of missed infection control care from nurses employed in hospitals located in three different countries. Data collection commenced mid-year 2018. Methods A multivariate approach was used to apply the consensus scores of 1.911 internationally based nurses in the missed opportunities for maintaining infection control. Results/findings Thirteen variables exert direct effects on the nurses' total scores underpinning missed infection control care. These include the methods used to prevent hospital-acquired infections, surveillance and hand hygiene practices. Significant nurses' demographic factors also included their countries of origin, employment status, employer type, job retention intentions, work intensity, length of clinical experience and staff development attendance. Conclusion In magnitude of importance and having the largest effect on missed infection control care is missed care related to reducing hospital-acquired infections followed closely by surveillance. Missed infection control care can be quantified, and variances in its practices can be accounted by exploring the nurses' differing demographic factors, including the nurses' country of origin. Impact Variations in missed infection control care can be accounted for across three countries. While ward hygiene is underestimated by staff as a mechanism to minimize nosocomial infections, infection control surveillance remains the key to reducing hospital-acquired infections. The study's outcomes invite the use of an ongoing, whole-of-organization approach to infection control with scrutiny being needed for improved staff adherence particularly with hand hygiene.

Aim The aim was to translate and validate the Missed Nursing Care in Infection Prevention and Control Survey for its use in the Lithuanian context. Methods A convenience sample of 331 nurses was surveyed. The study instrument explored missed care in the context of infection prevention and control practices. Rasch analysis was undertaken using Winsteps® Rasch measurement computer program and the generalized item response modelling software. Results The Missed Nursing Care in Infection Prevention and Control Survey in the Lithuanian language demonstrated unidimensionality and provided evidence of item fit to the modified instrument. The reliability of both sub-scales was 0.78 and 0.98, respectively. Differing consensus between the nurses based on their perceived frequencies and reasons of missed care was demonstrated. Conclusions The final Lithuanian version of the Missed Nursing Care in Infection Prevention and Control Survey consists of 29 items that assess type and frequency of missed care and 17 items that identify reasons for missed care. Implications for nursing management Unit managers will be able to use the modified scales to generate evidence as to the sources of missed infection control practices in their clinical areas and the rationale for the breaks in the hierarchy of mandatory infection prevention.

Aim To support the development of appropriate policies and actions in the field of missed nursing care (MNC). Background There has been an ever-growing international debate on MNC, interventions that nurses have identified as necessary for their patients, but which for various reasons they are unable to provide or are forced to delay. Despite MNC's relevance, its translation into policies and actions has not been documented to date. Method A consensus development method was employed involving (a) a nominal group composed of experts in the field, policymakers and the President of the Regional Nursing Professional Boards, and (b) 218 nurses appointed primarily at the managerial levels. Results A total of eight consensus statements were approved and organized in a series of sub-statements designed to (1) render the concept of MNC culturally acceptable in the Italian context, with the agreement that compromised nursing care (CNC) is the best term to be used in this field, as a synonym for MNC; (2) measure CNC as a strategy to increase patient safety; (3) select an appropriate CNC measurement tool; (4) optimize CNC measurement; (5) conduct effective CNC data analysis; (6) design and implement interventions to prevent and/or minimize CNC; (7) assess and disseminate findings on interventions' effectiveness; and (8) provide final remarks on the way to move forward. Conclusions We developed a process to introduce the phenomenon of MNC in the Italian culture and agreed firstly on the term compromised nursing care, which better reflects MNC's meaning according to the context and facilitates an open discussion on the phenomenon both within and outside the profession. The following consensus statements emerged represent a systematic approach, starting from the measurement and finishing with the re-measurement of the occurrence of MNC after having implemented concrete actions. Implications for nursing management The approved consensus statements can guide decision-makers to develop concrete policies and actions that promote the improvement of quality of care and patients' safety by minimizing and/or preventing MNC's occurrence.

Aim To compare the perceptions of nurses with infection control expertise and ward nurses as to what infection control activities are missed and the reasons why these activities are omitted. Background Infection prevention activities are viewed as important for reducing health care-acquired infections (HAIs) but are often poorly performed. Methods Data were collected through the Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey delivered to 500 Australian nurses prior to COVID-19. Results Significant differences were found on the mean scores between infection control and other nurses on ten items. In eight cases, five relating to hand hygiene, infection control specialists viewed the activity as more likely to be missed. Factors viewed as having greater contribution to omission of infection control prevention were as follows: 'Patients have to share bathrooms', 'Urgent patient situation' and 'Unexpected rise in patient volume and/or acuity on the ward/unit'. Infection control nurses were more likely to highlight the role of organisational and management factors in preventing effective infection control. Conclusions Differences in response between nurses suggest that the extent of omission of infection control precautions may be under-estimated by ward nurses. Implications for nursing management Infection control specialists are more likely to identify organisational barriers to effective infection control than other nurses. Work demands arising from pandemic management may contribute to infection control precautions being missed.

Background Research on missed nursing care reveals individual and systems failure. Research on infection control missed care is minimal. Aims Investigate nurse perceptions of missed infection control. Design Qualitative in-depth interviews with 11 Australian infection control nurse experts. Methods Participants were asked whether nursing and hospital-wide care tasks fundamental to infection control were missed, and what were the underlying causes and contributing factors for these omissions. Qualitative data was mapped against fundamental nursing practice and Australian infection control guidelines. Findings Omission of infection control care occur at the individual clinician and organisational level. Nurses describe failure to perform standard precautions as well as failure to perform basic care activities. Participants identified a range of institutional and cultural factors which contributed to cascade iatrogenesis resulting in healthcare associated infections for patients. Some factors are outside nurses’ control and include: environmental cleanliness; ward layout; ward culture; resourcing and staffing; integration of infection control into clinical governance; action following audit results; and reviewing evidence base of protocols. Discussion Care occurs in complex and conflicted settings, with prioritisation essential. Potentially harmful practices are generally done with the intention of care. Nurses are key, but not sole performers in the creation of quality infection control. Conclusion Mapping missed care related to infection control against standard frameworks of nursing practice revealed “gaps in the chain of infection” that contribute to “cascade iatrogenesis” with negative outcomes for patients.

Introduction The incidences and types of missed nursing care in the acute care and community sectors are both ubiquitous and quantifiable, however, there are few research studies relating to the type and frequency of missed maternity-based care for mothers and families. The aim of this study is to estimate the incidences and types of Australian missed midwifery care and to identify those factors that have causal links to it. Methods A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to ascertain consensus estimates made by Australian midwives. Electronic invitations were extended to their membership using an inclusive link to the MISSCARE survey. Inclusion criteria were all ANMF members who were midwives and currently employed within the Australian public and private healthcare systems. Data analysis was undertaken using both Rasch analysis and Structural Equation Modelling. Results The type and frequency of missed Australian midwifery care can be quantified and several demographic factors are significant predictor variables for overall missed midwifery care. The most prevalent aspects of missed care in the Australian midwifery setting are midwives’ hand hygiene, supportive care, perinatal education, and surveillance type midwifery practices. Conclusions As the frequencies and types of missed midwifery care in Australia have been identified, it is possible for midwives to be mindful of minimising care omissions related to hand hygiene, providing supportive care and education to mothers as well as surveillance-type midwifery practices.

The Australian government has reduced restrictions on ownership of residential aged care facilities (RACF) as part of aged care reform enabling the growth of private-for-profit ownership. This study explores the impact of private-for-profit ownership through comparison of perceptions of the volume of missed care in government, private-not-profit and for-profit RACF in Australia. Data were collected through development and administration of a MISSCARE survey to3,206 nurses and personal care workers (PCW) working in RACF and hospitals providing aged care services. Employees working within government owned facilities reported levels of missed care that are significantly lower than privately owned facilities on six activities: moving patients who cannot walk; assisting residents’ toileting within 5 min of request; assisting resident mouth care; assessing skin integrity; answering call bells within 5 min and wound care. Staffing levels were identified as the most common reason for missed care across all settings. Of the 27 factors identified as causing missed care, government employees reported significantly lower scores for 16 items. Further research is needed on the impact of facility ownership upon capacity of nurses and personal care workers to deliver care. Refereed/Peer-reviewed

Background The phenomena of missed nursing care is usually measured through quantitative surveys that detail the specific tasks that are rationed or delayed, and the reasons why this is so. These studies report high levels of agreement within and across countries between the two major measures employed; the Kalisch's MISSCARE tool and the RN4Cast Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Most of these studies have been conducted in acute care settings and demonstrate the impact of lack of human and other resources upon decisions to omit care. Less in known about missed care in residential aged care Aim To explore the frequency and causes of missed care in residential aged care in three Australian states: New South Wales, Victoria and South Australia. Methods Quantitative and qualitative data from 922 respondents working in residential aged care to the MISSCARE survey were bought together to identify the tasks missed in aged care and reasons for this. Findings Respondents report the omission of unplanned care (toileting and answering bells) and rehabilitative care. The primary reasons for missed care are staffing shortages and difficulties in meeting residents' complex health care needs due to demands arising from increased resident acuity and fewer skilled nurses to meet this demand. Conclusion Resident care is missed in residential aged care with staffing numbers identified as a key cause.

Aims To estimate and model the types and frequencies of care that nurses and carers self-identify as being missed in the Australian residential aged care sector. Background The study advances missed care research to explore how the care of elderly Australians is compromised. Methods A multi-variate approach was used to apply the consensus scores of 2,467 staff to missed opportunities for resident health promotion and restorative care. Results Eight latent care variables have direct predictor effects on missed Australian residential aged care, all of which are largely under the control of residential care management, with the exception of the physical locality of the aged care settings. Conclusion Missed care, associated with maximizing the residents' life potential, relieving their distress and maintaining their current health can be quantified and predicted. Implications for nursing management Aged care policies that maximize adequate staffing numbers with appropriate levels of skill are paramount to minimizing missed Australian residential care.

Background In order to meet national Australian nursing registration requisites, nurses need to meet competency requirements for evidence-based practices (EBPs). Aims A hypothetical model was formulated to explore factors that influenced Australian nursing students’ ability and achievement to understand and employ EBPs related to health care provision. Methods A nonexperimental, descriptive survey method was used to identify self-reported EBP efficacy estimates of 375 completing undergraduate nursing students. Factors influencing participants’ self-rated EBP abilities were validated by Rasch analysis and then modeled using the partial least squares analysis (PLS Path) program. Results Graduating nursing students’ ability to understand and apply EBPs for clinical improvement can be directly and indirectly predicted by eight variables including their understanding in the analysis, critique and synthesis of clinically based nursing research, their ability to communicate research to others and whether they had actually witnessed other staff delivering EBP. Linking Evidence to Action Forty-one percent of the variance in the nursing students’ self-rated EBP efficacy scores is able to be accounted for by this model. Previous exposure to EBP studies facilitates participants’ confidence with EBP, particularly with concurrent clinical EBP experiences.

This article examines missed care through dialogues examining the perceptions of nurses in regard to missed care occasions. Using a critical discourse analysis (CDA), the study explores the truth claims of participants who describe the challenges they encounter in daily attempts to deliver what they consider effective patient care. These are compared to the mandates of state and organisational policy prescribing clinical practice. The boundaries of tension that are expressed by nurses within the milieu of missed care are explored through in-depth interviews. CDA is interested in social organisation and the interplay of people's activities within it, the focus being on how they construe and internalise such activity. Nurses' perceptions and realities become central to any investigation because they are often organised by more than their own intentions or motivations, with influences such as professional standards or organisational rules subconsciously locating their reality. Instead of identifying occasions of omitted care, nurses spoke of constraints related to budget, staffing, skill mix and mandated policy as constraining their ability to complete care activities. Factors emerged that suggest that missed care is the consequence of routinised and standardised practice, cited as cost effective care, at the expense of professional autonomy. Refereed/Peer-reviewed

Missed nursing care and italian nursing practice: preliminary findings of a consensus conference. In recent years in Italy there has been renewed interest in missed nursing care due to various factors, such as participation in the RANCARE project, with 28 European and non-EU countries, the opportunity to develop international exchanges, specific projects and field based research. We explored a range of ideas and processes, culminating in a conference designed to address specific issues relating to missed nursing care, in the Italian nursing practice. After a preliminary review of the literature on the psychometric properties of the available tools, with the intent of further deepening our understanding of the concept of missed nursing care, its implications for practice, management, education and research. After two days of presentations and discussions, the more than participating nurses agreed on a set of preliminary recommendations regarding missed nursing care and Italian nursing practice. This paper reports on the preliminary consensus findings from the conference.

Aims This paper reports if estimates of final year nursing students’ self-rated abilities in responding to evidence-based practice (EBP) issues is a psychometrically robust measure. Background EBP as it applies to nursing continues to be heralded as a method to improve clinical patient care. Health professionals such as nurses are well positioned to respond to this demand; however, evidence suggests they are not always able to embrace this important foundation of everyday nursing practice. Design Instrument development. Methods The study was a survey set in a large teaching university in Adelaide, South Australia. The evidence-based practice survey was made available to a convenience sample of 471 final year nursing students, with a response rate of 79.6% (n = 375). Rasch analysis was used to critique and develop a scale for future learning based on the conjoint estimates of nursing students’ self-efficacy estimates, when meeting the challenges of various EBP of differing complexities. Results Outcomes confirm that final year nursing students’ EBP ability measures can be reliably estimated and a hierarchical scale of learning can be developed for use by beginning registered nurses’ in their staff development. Linking Evidence to Action Although Australian health and nursing authorities acknowledge the desirability of the nursing workforce in adopting EBP for patient management, elements of this approach remains problematic for nurses. Measures to estimate EBP skills difficulty can be reliably generated to inform EBP education and skills development.

Background: There is a growing nursing literature that views missed care as an inevitable consequence of work intensification associated with the rationing of nursing and material resources available to deliver care. Global studies recognize that missed care is now ubiquitous, although studies tend to be conducted in one region, rather than nationwide. This study seeks to understand the Australian context of missed care. Aims: To explore self-reported reasons for missed care and to identify the main factors for predicting missed care within a sample of Australian nurses and midwives working in public and private hospitals in New South Wales, Victoria, Tasmania, and South Australia. Methods: A nonexperimental, descriptive method using Kalisch's (2006) MISSCARE survey was used. Responses from 1,195 nursing and midwifery staff with differing qualifications, English language skills, and Australian employment settings were analyzed using Rasch analysis and then modeled using the Structural Equation Modeling. Results: The frequency of missed care on the morning shift directly impacted on higher priority care missed during the afternoon shift. Staff skill mix imbalances and perceived inadequacy of staff numbers for the work demands further exacerbated all aspects of care during afternoon shifts. Other major factors associated with missed care were the different clinical work settings and staff to patient ratios. Linking Evidence to Action: The incidences, types, and reasons behind missed care are a multidimensional construct which can be predicted when known significant factors behind missed care are simultaneously accounted for. Refereed/Peer-reviewed

Aims To measure and model Australian, Cypriot and Italian nurses’ beliefs about what care is missed and how frequently it occurs within their settings. Background This study expands on previous MISSCARE research but now applies and predicts missed care within three countries. Methods Multivariate analysis was performed to estimate 1,896 nurses’ consensus scores about missed care activities based on Alfaro-Lefevre's conceptual framework of care priorities. Results Five latent variables have direct predictor effects on missed care frequencies. Another four variables including the nurses’ age, highest qualifications, absenteeism rate and workplace type, contributed to explaining the overall variance of missed care scores. The nurses’ gender had no influence on missed care. Conclusion Cross country comparisons of missed nursing care allow for a more refined identification of strategies for remediation for both managers and clinicians. Implications for Nursing Management Reliable consensus estimates about the types and frequencies of missed care can be scaled with variables identified to predict missed care across three different countries. Comparative international studies build on the foundations for understanding missed care in terms of nursing practices, policies and related social policies.

Background and Purpose: Current measures of missed nursing care employ inventories of tasks which are rated for the frequency with which each is missed. These lists have shortcomings for research and clinical evaluation. There is a need for measures with less response burden, wider generalizability, and greater sensitivity and specificity for identifying poor quality care. Methods: We tested a single-item, global, measure using data from a large study of missed care in Australia. We employed traditional and innovative analysis techniques such as receiver operating characteristic curve and item response theory. Results: The single-item measure had adequate concurrent and convergent validity when compared to one list-format measure of missed care and strong sensitivity and specificity for identifying poor quality care. Conclusions: A well-crafted single-item measure, such as the one tested, can be useful for measuring missed nursing care. Refereed/Peer-reviewed

Aims and objectives This study explores the reasons nurses identify missed care and what factors account for this variance in nursing practice. Second, the study seeks to understand if the identified reasons behind missed care interact with one another and form a multidimensional construct. Background This study draws on the results of previous research conducted by Kalisch in developing the MISSCARE research survey tool and now applies it to an Australian context. Design This study engages a nonexperimental exploratory approach where 16 latent variables are identified and estimated using structural equation modelling to determine the capacity each of these factors has in predicting the reasons for reported missed nursing care. Methods Data were obtained from an electronic survey sent to nursing members of the Australian Nursing and Midwifery Federation of South Australia. A self-report, Likert-type instrument was used to capture the strength and direction of consensus derived from a sample of 289 nurses and midwives. Results/Findings Eight variables were identified as having direct predictor effects as to why nursing care was being missed, and included shift type, nursing resource allocation, health professional communication, workload intensity, workload predictability, the nurses' satisfaction with their current job and their intention to remain working. Additional indirect effects of other variables explained 34% of the variance of the total scores for why nursing care was reported as being missed. Conclusion Historically, the MISSCARE survey has identified and quantified what types of nursing care is missed. This paper takes this concept further by producing an interactional model identifying the effects different variables have on why nursing care is missed. Relevance to clinical practice These Australian findings not only contribute to other international studies that identify why nursing care is omitted, it provides a framework for why reported episodes of missed care can be predicted and subsequently addressed.

SUMMARY Background: It has previously been shown that nurses can learn clinical nursing skills by e-learning (online), and that many variables will influence how well nurses adopt learned clinical skills using distance education. Objectives: This study aimed to identify and measure the strength of those factors which would simultaneously influence registered nurses’ (RNs’) beliefs about their own learning about buttonhole cannulation, using e-learning. Design: An online Likert style survey consisting of a list of statements related to knowledge and skill domains considered crucial in the area of buttonhole cannulation was distributed to 101 RNs before and after completing an e-learning programme. Participants were required to identify their current level of self-confidence in relationship to each of the statements. Measurements: Measures of RNs’ self-rated abilities to assess and implement buttonhole cannulation after completing a related e-learning program were tested using a Partial Least Squares Analysis (PLS-PATH) programme. Results: The study’s results strongly identify that the nurses’ ability to meet both clinical and educational outcomes of the renal e-learning module can be predicted by six variables, none of which are directly related to the participants’ demographic or clinical backgrounds. Conclusion: These findings support the use of e-learning to teach clinical skills to RNs, and demonstrate the value of Partial Least Squares Analysis in determining influential learning factors.

Aims This paper is a report of a study, which seeks to determine if self-reported estimates of RNs' self-rated confidence in responding to alcohol use in patients is a psychometrically sound measure. Background Alcohol-related harm is a global public health problem. Nurses are the largest group of health professionals worldwide, with evidence showing that despite being well placed to respond, they are not engaging in this important role. Design Instrument development. Method The study was a survey set in a large teaching hospital in England, UK. The Clinical Confidence Questionnaire was made available to a convenience sample of 200 RNs in 2007, with a response rate of 22%. Rasch analysis was used to develop a scale for future learning based on the conjoint estimates of registered hospital nurses abilities to meet needs of patients requiring nursing care of different complexities related to alcohol use in patients. Results Outcomes verify that registered hospital nurses' self-rated clinical confidence measures for their own nursing abilities in responding to alcohol use in patients can be reliably estimated and a hierarchical scale of learning can be generated to inform curricula content and learning processes. Conclusion Current health policy in the UK identifies nurses as having a role in responding to alcohol-related harm. More focus should, therefore, be placed on ensuring that they are prepared to fully engage with patients in assessing and responding to alcohol use through specific education, training and skill development. The self-rated clinical confidence tool offers evidence as an acceptable method of measurement in this area.

PurposeThe purpose of this paper is to define and explore the concept of financial supply chain strategy in a global business environment. The paper aims to illustrate the concepts with a detailed case study of Motorola's global financial supply chain.Design/methodology/approachThis is a detailed, longitudinal case study analysis of a focal organisation and its economic partners in a financial supply chain. The case study combines qualitative analysis of the strategy evolution with extensive time‐series data and quantitative analyses of the performance of the financial supply chain.FindingsThe financial supply chain is an integral component of Motorola's overall supply chain management strategy. Physical product, information systems and financial flows are closely aligned with each other throughout the supply chain incorporating Motorola, its customers, suppliers and banks. The overall trend is towards the development of an integrated global financial supply chain in which cash flows mirror product flows. Motorola shares financial data with its suppliers as part of a cooperative strategy that generates cost savings for Motorola and its suppliers in areas such as foreign exchange and cash balances. The cooperative strategy also improves the quality of the payments process measured by six sigma techniques and produces strategic benefits such as risk reduction for the supply chain as a whole in areas such as foreign exchange and payments. A strategy of this type is only possible by taking a global perspective of the financial supply chain.Research limitations/implicationsThe development of financial supply chains has not been fully addressed in the supply chain management literature. This paper defines this relatively new topic area and explains its significance in its own right, and also in terms of the inter‐relationships between finance and manufacturing supply chains. A research agenda for financial supply chains is proposed that describes a range of new research opportunities in this area.Practical implicationsThe development of integrated financial supply chains will lead to significant savings in terms of funding, banking and administrative costs associated with treasury and payment activities. The implementation and nature of the strategic change also highlight important strategic planning and implementation issues associated with financial supply chains.Originality/valueThe strategic importance of financial supply chains for business and academic researchers is demonstrated through the definition of this topic and the application of a research framework to a detailed study of Motorola's global financial supply chain using time‐series data of strategy evolution and financial supply chain performance. The research findings and comparison with theory support the assertion that this is a relatively new and unexplored problem area that is of direct relevance and interest to researchers in supply chain management.

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified four strategies associated with NPM which add to workload after-hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care. Refereed/Peer-reviewed

A hypothetical model was formulated to explore which factors can simultaneously influence the self-reported ability of agricultural employees to embrace chemical safety practices. Eight variables were considered in the study, including the employees' gender, age, duration of current employment status, and whether they were employed full-time or part-time. The self-efficacy measures of 169 participants were then estimated by measuring their self-rated ability to understand and perform different chemical safety practices. Models identifying employee self-efficacy pathways leading to worker readiness to engage in chemical safety were then tested using Partial Least Squares Path Analysis. Study results suggest that employees' self-efficacy to successfully engage in safe chemical practices in their workplace can be directly predicted by four variables, with additional indirect effects offered by one other variable, which cumulatively account for 41% of the variance of employees' chemical safety self-efficacy scores. The most significant predictor variables that directly influenced employees' self-efficacy in adopting chemical safety practices in the workplace were worker age, gender, years of employment, and concurrent confidence (self-efficacy) arising from prior experience using chemicals in the workplace. The variables of employees' prior knowledge and understanding about the use of administrative controls and personal protective equipment to protect workers from chemical exposure had no direct influence on self-efficacy to handle chemical emergencies. Employees' unfamiliarity with risk control strategies and reliance on material safety data sheets for information suggest that ongoing and targeted training are necessary if chemical safety issues are to be addressed.

There is a growing nursing literature that views missed nursing care as an inevitable consequence of work intensification associated with the rationing of the human and material resources required to deliver care. A modified MISSCARE survey was administered to 4431 nurses and midwives in New South Wales in November 2014. This paper reports on 947 responses to an open question contained in the survey which asked respondents 'Is there anything else you would like to tell us about missed care?' Responses were analysed using qualitative content analysis and focused upon both the causes and impact of missed care. Analysis identified two major causes of missed care: the impact of work intensification and staffing issues. Participants associated work intensification with patient acuity and cost containment, while the staffing issues identified included: undermining prescribed staffing ratios; skill mix; changing workloads across shifts; and poor support from other staff. Respondents identified insufficient resources, albeit staffing or other resources, to meet patient care needs reflecting findings in similar studies. Missed or delayed nursing care in this context is associated with resource issues leading nurses to ration the care they can provide. While work intensification is not a new phenomenon, its increasing use in the public hospital sector across a number of OECD countries has become a major consequence of new public management (NPM) strategies aimed at cost containment. Refereed/Peer-reviewed

In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour. Refereed/Peer-reviewed

Like any other retailers, web-based businesses face the challenge of attracting consumers to their stores (sites). In the case of offline retailers, location and brand are often identified as the most significant influences on store traffic. For web-based retailers, however, relatively little is known about the factors that attract visitors to sites. One potential method of attracting customer visits is links from other web sites, which may be viewed as a referral (e.g. word-of-mouth) from a trusted third party. To examine the importance of links we model the number of visits to individual internet retail stores as a function of the number of links each has with other sites and the information/product content of the internet retail store. Using data from Alexa.com ( ) we test our model with the top 500 companies across five different industries. The results demonstrate that the number of links to a particular internet retail store explains over 60% of the variance of site traffic between different sites and that there is a very high level of industry concentration in all five sectors. These findings raise interesting issues for the design and implementation of strategies for attracting customers to Internet sites.

The way market research is conducted has changed dramatically over the past 30 years, as a result of both the development of the prevailing view of best practice and the state of technology available to researchers. While it is clear that the World Wide Web (WWW) will increasingly be used as a medium for conducting market research, the full implications of this new channel are not yet fully understood. This paper examines the potential for an Internet‐based financial services firm (Xenon Laboratories) to analyse conduct market research using the WWW. The case demonstrates that, by employing a novel approach to market research, Xenon Laboratories is in a unique position to understand the charging structures in its market, the market for international payments using credit or charge cards. In doing so, the paper highlights the opportunity to unobtrusively gather market information from an international group of customers by providing Internet‐based value‐added services.

Work intensification is assumed to incorporate either longer working hours or a quickening of the pace or speed of work. In this paper, we argue that ‘missed care’ is a proxy for work intensification or work effort in nursing. Using Kalisch’s MISSCARE survey tool, with modifications to suit the South Australian context we surveyed 354 registered and enrolled nurses between October and December 2012. Survey participants were recruited through the Australian Nursing and Midwifery Federation (SA Branch). The MISSCARE survey tool presents participants with a 5-point scale where 1 is never omitted care and 5 is always omitted care. Survey findings suggest that the tasks most often missed are ambulation of patients and mouth care. Tasks lest likely to be missed are blood glucose monitoring; hand washing; IV/central line care and providing PRN medication within 15 minutes. These findings suggest that when nurses are forced to ration care, priority is given to clinical tasks that will impact on immediate patient outcomes. In identifying the reasons why they missed care, nurses reported that while staffing often appeared adequate, sudden and unexpected rises in patient volume, heavy admissions and discharges, and inadequate numbers of staff or clerical support were key indicators of missed care. These unpredictable events resulted in an increase in work intensity and pace that was independent of extended working hours or overtime. We argue that one of the outcomes of work intensification is missed care. Refereed/Peer-reviewed

Since 2006, US nurse Beatrice Kalisch has explored the relationships among the work environment, patient care demands and staffing issues on nursing outcomes (Kalisch 2006). Subsequently, the MISSCARE (Kalisch and Williams 2009) tool was developed to quantify what types and how frequently nursing care was missed and why omissions occurred. The MISSCARE survey has become one measure in the transactions of nursing, which refers to any aspect of care that is entirely or partially omitted or deferred. The tool comprises two portions: the elements of missed nursing care, containing 24 items where nurse participants are asked to rate how often each care aspect was missed with the options ranging from “rarely,” “occasionally,” “frequently,” and “always” missed. The second component explores the reasons for missed nursing care, with 17 varied reasons for why nursing care was missed within their work area. The scale used offered four options indicating degrees of intensity for why care was missed: if it was a “significant reason,” “moderate reason,” “minor reason,” or “not a reason” for missed care Refereed/Peer-reviewed

Aim To report on a study measuring midwifery students’ self-reported abilities in teaching and supervising breastfeeding mothers. Abilities were assessed at two time intervals, before and after completing a maternal and infant nutrition topic with simultaneous clinical opportunities to consolidate their skills. Method A convenience sample of midwifery students in an Australian university completed a pre- and post-intervention survey to assess their self-rated ability to teach and supervise breastfeeding mothers. Rasch analysis was used to gain conjoint estimates of students’ self-reported abilities to teach and supervise breastfeeding mothers across 37 items with varying complexity of care needs. Rasch analysis was used to determine validity and reliability of the 37-item tool, to develop a hierarchical linear scale reflecting difficulty of breastfeeding supportive activities, and to determine student learning between the two time points. Results From 95 responses, 34 of the 37 items met the requirement for unidimensionality. Outcomes identified that midwifery students’ self-efficacy measures for breastfeeding support abilities can be reliably estimated. A hierarchical scale for learning these clinical skills has been generated to inform curricula development and learning processes. While there was an overall increase in the ease of difficulty of 21 items in the survey at time point two, eight items were identified as becoming more difficult. Conclusion The findings of this study challenge midwifery educators to reconsider the educational activities provided for midwifery students’ that aim to develop the requisite skills to provide effective breastfeeding support, including the provision of specific clinical opportunities to learn from breastfeeding women.

Although there has been an increase in the overall financial services market, the profitability of banks world-wide has decreased from the early 1980s to the 1990s. This has been attributed to several factors: the decline of traditional banking activities (deposit taking and lending); poorly performing debts (arising from poor lending decisions); and, for domestic banks, depressed property prices and important local industrial sectors performing badly. However, the analyses of bank performance tend to be short-term and narrow in their outlook, and seldom attempt to explain the underlying trends and processes of change. In this paper it is argued that the broad competitive forces of information technology, globalisation and deregulation are destabilising the banking industry leading to irrevocable changes which allow new entrants, disintermediation, innovation and customer changes on a much greater scale than has occurred in the past. These concepts are illustrated using a range of different bank markets as examples. To compete in these new markets different approaches are needed, and a series of possible strategies for addressing new bank markets are outlined with reference to size and type of bank. The long-term outlook for banking is discussed with particular attention being focussed on the changing role of universal banks.

A review of the various models of New Product Development (NPD) process shows that although different approaches have been proposed, they are in fact all variants on a linear theme: some may include feedback loops, but they all essentially advocate that certain steps precede, or are preceded by, others. An inevitable consequence on the Internet/World Wide Web (WWW or Web) is that such models are no longer applicable. Based on the lessons learned from the development of a new financial service offered via the Internet, we show how such assumptions of linearity need no longer be a constraint. In addition, innovativeness is not related to firm size. But the fact that the Web allows for the real-time development of new financial services based on on-going feedback from potential and current customers raises a new set of managerial issues that have to be tackled. The objective of this paper is to use the context of the recent launch of an innovative financial service product via the Web to explore the managerial changes that are starting to affect the banking industry.

This paper charts the progress of Motorola's global cash management strategy encompassing Motorola's internal factories worldwide, Motorola's customers and suppliers, and partner banks in the US, Europe and Asia. It explains how their financial supply chain strategy has evolved over a period of over thirty five years from a relatively simple internally focused system into a fully integrated global system that enables the flow of currency and associated foreign exchange processes to mirror the Just-In-Time (JIT) flow of products throughout the supply chain. The performance of the finance systems is analyzed using detailed statistical techniques including six-sigma. The strategy is characterized by incremental changes punctuated by significant shifts in the strategy, organizational design and information systems. It is demonstrated that the financial processes that connect Motorola with its suppliers enable the supply chain to behave more like a single, cohesive unit rather than a collection of autonomous organizational units.

Introduction A one-level hypothetical model was formulated to explore factors that influenced the selfreported readiness of workplace managers to engage in workplace (vocational) rehabilitation of past-injured workers attending their workplaces. Methods Seven supervisor latent variables were considered, using 270 supervisors self-rated self-efficacy measures, estimating their ability to pursue four related roles associated with vocational rehabilitation in the workplace. Models identifying supervisor self-efficacy pathways leading to their readiness to engage in vocational rehabilitation in their workplaces were tested using Partial Least Square Analysis (PLSPATH). Results The study's outcomes suggest that supervisor readiness to engage in workplace vocational rehabilitation with rehabilitating employees can be directly associated with four variables. Together, these variables accounted for 41 per cent of the variance of the supervisors' self-efficacy scores, defining their readiness to engage in workplace vocational rehabilitation. Significant predictors which had a direct influence on supervisor readiness to engage in vocational rehabilitation were: their perceived financial and liaison roles associated with vocational rehabilitation and their concern with meeting legal aspects of this process. The capacity of the supervisor to interact with others within the workplace organisation when engaging in vocational rehabilitation was also seen as a significant determinant of their readiness to engage in rehabilitation activities. The gender of the supervisor or the number of employees for whom the supervisor was responsible for, were found to have no significant influence on their self-efficacy levels. Conclusions Statistically significant supervisory readiness to engage in vocational workplace rehabilitation is subject to their self-rated abilities to undertake multiple roles involved with the rehabilitation process and a more reflective approach is warranted to prepare supervisors for this role. Refereed/Peer-reviewed

The financial services market is currently undergoing tremendous change, due to the twin influences of developments in the field of Electronic Data Interchange (EDI) and changes in the legislation determining how banks will be allowed to operate after 1992. Describes research whose objective was to evaluate the viability of introducing a new service to handle cross‐border payments, undertaken for a large multinational bank, and focused on respondents from a variety of firms within the European Community. Uses a combination of a PC‐based judgemental modelling package and in‐depth interviews to develop a clear understanding of the needs of both the originators′ and the vendors′ requirements. Although based on a relatively small sample, the detailed findings permit development of an effective approach to segmenting the market for the particular service.

There is an abundance of literature about the impact of the new electronic communications technologies and most of the authors attest to its value and theoretical benefits. Many organizations are working in this area and producing novel implementations, but for the general company there is little that is of help in planning for these systems. In order to overcome this deficiency, this article presents a detailed analysis of electronic data interchange (EDI) undertaken by a large number of U.S. companies. The results suggest a model of strategic implementation which illustrates how factors such as the nature of markets and distribution channels, organizational structure and process and buyer power influence the implementation of EDI with suppliers and customers. Five generic EDI strategies have been identified and the impact of market share and IT expertise on these are discussed. Finally, the authors give their views on some of the long–term issues and suggest some possible outcomes.

Quality of Life (QoL) is a subjective perception a person has of their position in life. Tailoring care to a patient's unique needs requires nurses and patients to have a similar understanding of a patients' QoL. This study aimed to identify: (a) the level of agreement between patients and nurses about cancer patients' QoL; and (b) variables that may affect the level of agreement between them. Cancer patients (n=117) and nurses (n=49) from a public hospital were invited separately to complete the World Health Organisation Quality of Life Brief (WHOQoL-BREF) questionnaire. This assesses QoL in physical, psychological, social relationship and environmental domains, or dimensions. Intraclass correlation coefficients (ICC) revealed a moderate agreement between nurses' and patients' scores in the physical QoL domain but lower agreement on other domains. A paired t-test identified patients' QoL domain scores were significantly higher than that of nurses in social relationship and environmental domains. Multivariate analysis using standard multiple regression analysis demonstrated that agreement between patients and nurses was higher: (a) in the physical QoL domain with nurses who have greater clinical experience with cancer patients; (b) in the social relationship QoL domain when patients are treated in outpatient departments. These results imply that differences exist between patients' and nurses' perceptions about cancer patients' QoL and nurses tend to underestimate patients' QoL in social relationship and environmental domains. Higher clinical experience with cancer patients may contribute toward a better understanding by nurses of cancer patients' QoL.

Information systems have developed along the supply chain to support logistics management in all types of industries. Most of this effort has been focused at reducing the levels of working capital by increasing the efficiency of information flow from market to raw materials suppliers. Similar developments have also occurred to support other business processes, for example connecting together new product design and marketing databases to create virtual corporations. Electronic commerce and associated technologies such as EDI are the norm in advanced supply chains and it is common for their use to be mandatory when trading with large companies. The manufacturing of a product is now seen as a whole process across the supply chain rather than a series of separate operations managed and controlled by different organisations. The management of logistics has been fundamentally re-engineered and designed to focus on quality and time-based strategies. However developments in the handling of financial information between functions within companies and across organisational boundaries have lagged far behind the developments in logistics management. This paper explores the potential benefits of cooperative relationships in the financial supply chain to reduce the time delays and increase the level of certainty regarding financial transactions between separate organisations. The financial benefits are estimated using published data to provide a potential saving of 3.8% of the value of the transaction. An organizational model is presented of likely future developments and steps that can be taken by the financial service industry to benefit as integrated providers of financial services to supply chains and the areas for initial implementation are outlined.

This paper explores the application of the Rasch model in developing and subsequently analysing data derived from a series of rating scales that measures the preparedness of participants to engage in workplace rehabilitation. Brief consideration is given to the relationship between effect and learning together with an overview of how the rating scales were developed in terms of their content and processes. Emphasis is then placed on how the principles of Rasch scaling can be applied to rating scale calibration and analysis. Data derived from the application of the Workplace Rehabilitation Scale are then examined for the evidence of differentiated item function (DIF).

The nature of how marketing research is conducted has changed dramatically over the past thirty years. This has been a function both of how the prevailing view of best practice in marketing has developed, and also of the state of technology available to researchers. While it is clear that the WWW will increasingly be used as a medium for conducting marketing research, the full implications of this new medium are not yet fully understood. Existing research has examined the implications of the WWW in terms of the potential dramatic reductions in both the time and cost involved in testing new financial service products. The potential for a financial services firm to analyse the market environment and competitors' strategies is examined using a case study based on real time marketing research. The case is that of the Canadian Internet financial services provider, Xenon Laboratories, which conducts marketing research into the market for credit/charge cards.

The profitability of banks world-wide has decreased from the early 1980s to the 1990s. This has been attributed to several factors: the decline of traditional banking activities (deposit taking and lending), poorly performing debts (arising from poor lending decisions) and for domestic banks to factors such as depressed property prices and important local industrial sectors performing badly. However the analyses of bank performance tend to be short-term and narrow in their outlook, and seldom attempt to explain the underlying trends and processes of change. It is argued that the broad competitive forces of information technology, globalisation and deregulation are de-stabilising the banking industry which leads to irrevocable changes which allow new entrants, disintermediation, innovation and customer changes on a much greater scale than has occurred in the past. These concepts are illustrated using a range of different bank markets as examples. To compete in these new markets different approaches are needed. Possible strategies for addressing new bank markets are outlined with reference to size and type of bank and the long-term outlook for banking is discussed.

A review of the various models of New Product Development (NPD) process shows that although different approaches have been proposed, they are in fact all variants on a linear theme: some may include feedback loops, but they all essentially advocate that certain steps precede, or are preceded by, others. An inevitable consequence on the Internet/World Wide Web (WWW or Web) is that such models are no longer applicable. Based on the lessons learned from the development of a new financial service offered via the Internet, we show how such assumptions of linearity need no longer be a constraint. In addition, innovativeness is not related to firm size. But the fact that the Web allows for the real-time development of new financial services based on on-going feedback from potential and current customers raises a new set of managerial issue that have to be tackled. The objective of this paper is to use the context of the recent launch of an innovative financial services product via the Web to explore the managerial changes that are starting to affect the banking industry.

The set of interorganizational information systems used for global cash management in business markets is analyzed. A longitudinal case study of Motorola is presented. Their strategy has evolved from an internal cost saving focus to a cooperative one, yielding significant strategic benefits by the inclusion of trading partners. The financial aspects of Motorola's business relationships with trading partners and its principal bank have been transformed through a process of organizational learning and adaptation coupled with the close integration of information systems (ISs) throughout the cash supply chain. Cooperative behavior between Motorola and its suppliers, with the help of Citibank, has enabled a coordinated response to bring cash flows in line with product flows. The results are compared with existing IS marketing theories on business relationships, market structure, and globalization. >