Objective : The purpose of the present study is to investigate perceptions by paramedics and hospital receiving staff about what enables and constrains handover in the ED. Methods:This is a qualitative study of interviews with 19 paramedics, 15 nurses and 16 doctors (n = 50) from ambulance services and ED in two states of Australia. Results:Three main themes emerged that were evident at both sites and in the three professional groups. These were: difficulties in creating a shared cognitive picture, tensions between 'doing' and 'listening' and fragmenting communication. Conclusion:Recommendations arising from the present study as to how handover could be improved are the need for a common language between paramedics and staff in the ED, for shared experiences and understanding between the members of the team and for the development of a standardized approach to handover from paramedics to ED receiving staff. Key words:handover, paramedic to emergency department interaction, patient safety, qualitative research.In a recent issue in this journal, Yong et al. acknowledged that although emergency physicians are generally satisfied with paramedic handover, there is scope for improved doctor-paramedic communication at handover. 1 The study by Yong et al. is timely and highlights the paucity of research, particularly in Australia, on prehospital to ED handovers, including a significant knowledge gap on staff perception of handovers and handover information. This is particularly important given the increasing recognition of the importance of effective clinical handover as a major determinant for patient safety. The purpose of the present paper is to report on a qualitative study investigating perceptions by paramedics and receiving hospital nursing and medical staff about what enables and constrains effective handover in the ED and to develop recommendations to improve handover between paramedics and hospital receiving staff. The paper complements and extends the work of Yong et al.,

Ageing in Place policies have transferred responsibility for many frail elderly people and those living with dementia from residential to in-home care. Despite this placing a greater obligation on families, in Australia carers continue to under-use day respite services. This qualitative design study identified issues around the use of day respite care from the perspective of the family carer, focusing on barriers to attendance and strategies to facilitate attendance. Telephone interviews were held in 2007 with Tasmanian carers whose family member refused to attend day respite care (ten carers) and those whose family member attended (17). Carers considering day respite care were often overwhelmed by the quantity of information, confused about the process, and worried about the recipient's safety in an unfamiliar environment. They felt anxious about public acknowledgement of the condition leading to fear of embarrassment. Day respite care users appreciated the break it provided them and the opportunity for their family member to socialise. To facilitate a greater uptake of day respite care, reliable information sources and strategies to help carers deal with the emotions they face on a daily basis, together with a wider social acceptance of dementia, are important. Furthermore, carers need an opportunity to talk with others, enabling them to gain support from those who have successfully introduced a family member to day respite care.

This paper is about women nurse veterans from the Royal Australian Army Nursing Corps (RAANC) who served in Vietnam. I aim to develop an understanding about these nurses that might place their experiences into a wider context. My conclusions provide starting points for future studies on myth, remembering and oral history.

Purpose – The purpose of this paper is to investigate to what extent an engaging or authentic leadership style is related to higher levels of patient safety performance. Design/methodology/approach – A survey and/or interview of 53 medical and dental staff on their perceptions of leadership style in their unit was conducted. Scores obtained from 51 responses were averaged for each question and overall performance was compared with unit specific hand hygiene (HH) compliance data. Interview material was transcribed and analysed independently by each member of the research team. Findings – A modest negative relationship between this leadership style and hand hygiene compliance rates (r=0.37) was found. Interview data revealed that environmental factors, role modelling by the leader and education to counter false beliefs about hand hygiene and infection control may be more important determinants of patient safety performance in this regard than actual overall leadership style. Research limitations/implications – The sample was relatively small, other attributes of leaders were not investigated. Practical implications – Leadership development for clinicians may need to focus on situational or adaptive capacity rather than a specific style. In the case of improving patient safety through increasing HH compliance, a more directive approach with clear statements backed up by role modelling appears likely to produce better rates. Originality/value – Little is known about patient safety and clinical leadership. Much of the current focus is on developing transformational, authentic or engaging style. This study provides some evidence that it should not be used exclusively.

Pregnant adolescents and teenage mothers in rural communities face extraordinary difficulties accessing appropriate and adequate support services, despite having recognised specialist health needs and unique support requirements. The Australian Rural Health Research Institute at Charles Sturt University, Wagga Wagga, is currently engaged in a federally funded project aimed it significantly improving access to services for this disadvantaged and often neglected group, through the publication and wide dissemination of a resource booklet identifying successful aspects of service delivery across a range of rural support settings. Five existing health and welfare support services for pregnant or parenting adolescent: in rural Australia have been selected for inclusion in the booklet, which is being developed for community use. Assessment is being undertaken during visits to each of the services, and, following interviews with staff, referral agencies and consumers. This paper outlines the strengths, attributes and access difficulties associated with two contrasting service models involved in the project, and stresses the importance of improving access to services for rural adolescents. A framework for establishing innovative and effective new services is also presented.