Should patients in a persistent vegetative state be allowed to die? Guidelines for a new standard of care in Australian hospitals.

In this article we will be arguing in favour of legislating to protect doctors who bring about the deaths of PVS patients, regardless of whether the death is through passive means (e.g. the discontinuation of artificial feeding and respiration) or active means (e.g. through the administration of pharmaceuticals known to hasten death in end-of-life care). We will first discuss the ethical dilemmas doctors and lawmakers faced in the more famous PVS cases arising in the US and UK, before exploring what the law should be regarding such patients, particularly in Australia. We will continue by arguing in favour of allowing euthanasia in the interests of PVS patients, their families, and finally the wider community, before concluding with some suggestions for how these ethical arguments could be transformed into a set of guidelines for medical practice in this area.

Nurse practitioner work: A case study.

Abstract Within any professional practice, knowledge developments to support service delivery and to understand roles inherent within that practice context are critical. The purpose of this article is to present findings from case study research that used the AUSPRAC Research Toolkit Interview Schedule and to propose an additional theme to the Interview Schedule. Case Study method was used to explore the role of a nurse practitioner (NP) within a specific context of practice in an Australian Healthcare institution. Three semi-structured interviews with a NP using the AUSPRAC Research Toolkit Interview Schedule and one additional interview were employed. Data was analysed where initial free coding, then theme generation contributed to knowledge development. The AUSPRAC Research Toolkit Interview Schedule generated knowledge about the NP role. Themes identified for interviews in the Schedule were: the organisation of care, team functioning and patient service. Analysis of data from these themes identified that information related to ongoing development of professional practice was not forthcoming from the participant. The authors recommend adding a fourth theme to the Interview Schedule to enable exploration of the professional elements of the NP role.

The Nurse Practitioner Role: A pilot study based on the Interview Schedule from the AUSPRAC Research Toolkit.

Abstract Within any professional practice, knowledge developments to support service delivery and to understand roles inherent within that practice context are critical. The purpose of this article is to present findings from case study research that used the AUSPRAC Research Toolkit Interview Schedule and to propose an additional theme to the Interview Schedule. Case Study method was used to explore the role of a nurse practitioner within a specific context of practice in an Australian Healthcare institution. Three semi-structured interviews with a Nurse Practitioner using the AUSPRAC Research Toolkit Interview Schedule and one additional interview were employed. Data was analysed where initial free coding, then theme generation contributed to knowledge development. The AUSPRAC Research Toolkit Interview Schedule generated knowledge about the nurse practitioner role. Themes identified for interviews in the Schedule were; the organisation of care, team functioning and patient service. Analysis of data from these themes identified that information related to ongoing development of professional practice was not forthcoming from the participant. The authors recommend adding a fourth theme to the Interview Schedule to enable exploration of the professional elements of the Nurse Practitioner role.

Appearance matters: the frame and focus of health messages influences beliefs about skin cancer.

OBJECTIVES: This study sought to ascertain whether the health message 'framing effect', which has been observed for several diseases, occurs for messages concerning the consequences of skin cancer for one's appearance or one's health. Specifically, the effect of the frame and focus of health messages on intentions to perform skin protection behaviours and the perceived threat of skin cancer was investigated. DESIGN: Consistent with previous research and to avoid carry-over effects, a two-factor, between-groups (message frame: gain vs. loss × message focus: appearance vs. health) design was used. METHODS: Participants (N= 390) were recruited using convenience sampling and presented with one of four health messages, which were embedded in a questionnaire concerning beliefs about skin cancer (intentions to perform different skin protection behaviours, the perceived threat of skin cancer) and body consciousness. The health messages were framed in terms of loss (risks of sun exposure) or gain (benefits of skin protection) and focused on the consequences of sun exposure for one's appearance or one's health. The primary outcome measures were responses on rating scales concerning the perceived threat of skin cancer, intentions to perform different skin cancer protection behaviours, and body consciousness. RESULTS: Perceived threat of skin cancer was found to be greater for appearance-focused messages and intentions to perform different skin protection behaviours were greater for loss-framed messages. These findings held when individual differences in body consciousness were controlled for. CONCLUSIONS: These findings suggest that, for the communication of information about skin cancer to be effective, messages must focus on the impact of sun exposure and inadequate skin protection for people's appearance, not just their health. Moreover, to maximize effectiveness, health messages about skin cancer should take account of dispositional differences in the importance placed upon one's appearance.

The relationship between prostate cancer knowledge and beliefs and intentions to attend PSA screening among at-risk men.

OBJECTIVE: To examine the level of knowledge regarding prostate cancer and screening, to investigate prostate cancer illness perceptions, and to test the efficacy of the theory of planned behaviour (TPB) for understanding intentions to attend prostate-specific antigen (PSA) screening, when offered by a doctor or self-initiated. METHODS: Two hundred and twenty three men completed the PROCASE knowledge scale, the Revised Illness Perceptions Questionnaire and a questionnaire developed to assess attitudes, subjective norms and perceived control over intentions to attend for PSA testing. RESULTS: Participants had a high level of knowledge and accurate perceptions of prostate cancer. Controlling for knowledge and experience with prostate cancer, the TPB accounted for 49% (p<0.001) of the variation in intentions to attend if recommended by a doctor. CONCLUSION: The sample of at-risk men were characterised by good knowledge, accurate mental representation of prostate cancer, and positive beliefs towards the PSA test. Components of the TPB accounted for statistically significant amounts of variation in intentions to attend for testing. PRACTICE IMPLICATIONS: Beliefs about prostate cancer do not appear to influence PSA testing intentions; healthcare providers' recommendations may have the strongest influence on decisions to attend for PSA testing.

A national survey of telemedicine in the Republic of Ireland.

We conducted a national survey of hospitals in the Republic of Ireland to assess their use of telemedicine. Information was sought from 187 hospitals and replies were received from 157, a response rate of 84%. Activity was identified in a total of 40 hospitals (25% of the respondents). The main disciplines using telemedicine were radiology, pathology, neurosurgery, oncology and paediatrics, and the main applications were teleradiology (25 hospitals), videoconferencing (16) and telepathology (5). Dublin, the capital city, was found to act as a centre for telemedicine activity for the whole country. A number of regional networks had developed in the east, but the pattern of development in the west was very different where there were mainly isolated links. One fully operational national network was found but this was only used for consultation in one discipline (neurosurgery). It appears that the development of telemedicine in the Republic of Ireland has been unplanned. A national telemedicine strategy might lead to an integrated national network in the future, which could help to provide more equitable access to health care.