Applying a quality use of medicines framework to using essential oils in nursing practice

Nurses are increasingly incorporating complementary therapies into their practices. Aromatherapy is one of the most popular therapies. The basis of aromatherapy is essential oils, which are chemically active substances with a long history of safe traditional use and a growing evidence base to support their use in nursing care. In Australia, essential oils are classified and regulated under the same policies as conventional medicines such as the National Medicines Policy and the Quality Use of Medicines (QUM) framework applies. QUM is a framework for selecting and using medicines safely and effectively if medicines are indicated. The key elements of QUM are a systems-based approach to using medicines based on relevant evidence, partnerships, and informed client consent. Clients are placed at the centre of a QUM medication management process, which is consistent with holistic care. Applying a QUM approach to essential oil use, Quality Use of Essential Oils (QUEO), involves developing effective systems for managing essential oils from an holistic perspective that includes structured assessment and diagnostic processes to enable effective essential oil prescribing and outcome monitoring. In a QUEO approach, essential oils are integrated into the client's overall medication regimen and care plan rather than being used as ‘add-ons’. Adopting QUEO is consistent with the current national focus on the quality use of therapeutic substances, increases the profile of aromatherapy in nursing care and provides important information to guide future aromatherapy practices.

Projections of the future path of the gender wage gap in Great Britain

Purpose – The paper attempts to project the future trend of the gender wage gap in Great Britain up to 2031.
Design/methodology/approach – The empirical analysis utilises the British Household Panel Study Wave F together with Office for National Statistics (ONS) demographic projections. The methodology combines the ONS projections with assumptions relating to the evolution of educational attainment in order to project the future distribution of human capital skills and consequently the future size of the gender wage gap.
Findings – The analysis suggests that gender wage convergence will be slow, with little female progress by 2031 unless there is a large rise in returns to female experience.
Originality/value – The paper has projected the pattern of male and female skill acquisition together with the associated trend in wages up to 2031.

Ontological possibilities the rethinking teaching on the "nature of science"

An extensive literature documents teachers’ failure to include ideas about the 'nature of science' (NOS) in their classroom programmes, despite widespread advocacy for this as an essential component of more inclusive science teaching. This thesis frames much of the existing NOS literature as a deficit literature that focuses on epistemology, while largely ignoring the ontological realities of the classroom and overestimating individual teacher’s agency to change their enacted curriculum. Epistemologically-focused NOS reforms are positioned as curriculum 'add-ons', which teachers are likely to ignore. A NOS focus on ontology would entail curriculum restructuring, attending first to the contexts in which scientific knowledge is produced, and the ways it acts in the world. In any case, science itself has changed in recent years. Drawing from the sociology of science, in particular the work of Bruno Latour, the thesis compares traditional philosophical thinking about the ontology of science with more recent 'networked' views. Brent Davis explains the educational implications of key ideas from complexity science. Political philosopher Stephen White adds an ethical dimension. His ideas are used to argue for replacing 'strong' ontologies of realist science with more nuanced and actively tended 'weak' ontologies, as appropriate to the rapid sociological changes of the twenty-first century. The thesis argues that epistemological uncertainties that could lead to the suspicion of relativism are potentially threatening in the classroom because of hegemonic pressures towards consensus and a certain, safe status for the knowledge taught. Seeking an alternative pathway to change, Daniel Liston’s conceptualisation of teaching as a passionate act informs the analysis of the empirical component of the thesis. Eight recipients of New Zealand Royal Society Science Teacher Fellowships were interviewed on four occasions over two years. They discussed their personal learning during a year-long sabbatical to carry out an extended science investigation and their thoughts and actions on returning to the classroom. Narrative methodology is used to explore the teachers’ stories, revealing both passion for their personal learning and an ethical concern for their students’ learning to care for both the natural world and science as a means of its investigation. The thesis argues for the use of ontological approaches to the initial introduction of NOS ideas in school science, with epistemological concepts added only once a topic has been grounded in what Latour calls 'matters of concern'.Two potential teaching strategies—the production of network diagrams and the use of Davis's 'bifurcations'as a critical inquiry tool—are the focus of hypothetical experimentation. First in the context of global warming, and then addressing the challenges posed to teaching evolution by the proponents of 'intelligent design', these strategies are shown to have the potential to address some of science education’ s thornier issues, not just the NOS question. However, when conflicting expectations create tensions for teachers in the classroom moment, it is difficult for them to introduce reflective, deeply philosophical changes to their representation of science. Their working realities need to be acknowledged, and the tensions ameliorated, if we expect substantive change in their current practice.

Animals in international development, poverty reduction and sustainable livelihoods

This paper explores the role and percept¡ons of an¡mals in internat¡onal development efforts and the possible contradictions between differing priorities of agencies involved in internat¡onal charitable efforts. The description ofthe differing descriptions of purposes in the (England and Wales) Charities Act of 2006 prov¡des a good starting point. There are many available purposes for charities, and although having one purpose does not preclude a second, organizations concerned with animal welfare appear to be quite d¡stinct from those work¡ng for poverty alleviation in the developing world. A fun and novel gift of a donkey may equally be perceived as a cruel, environmentally unsustainable and misguided development effort, a valuable asset for a household, or a burden to a household struggling to feed existing mouths..... This paper questions the underlying tensions between human development, animal welfare, and poverty alleviation exploring cultural tensions, philosophical tens¡ons and where areas of common ground may be found.

Do indicated preventive interventions for depression represent good value for money?

The prevention of depression is of growing interest to researchers and policy makers. However, the question of whether interventions designed to prevent depression provide value for money at a population level remains largely unanswered. The current study assesses the cost-effectiveness of two indicated interventions designed to prevent depression: a brief psychological intervention based on bibliotherapy and a more comprehensive group-based psychological intervention following opportunistic screening for sub-syndromal depression in general practice. Method: Economic modelling using a cost utility framework was used to assess the incremental cost effectiveness ratios (ICERs) of the two interventions within the Australian population context, modelled as add-ons to current practice. The perspective was the health sector and outcomes were measured using disability-adjusted life years (DALYs). Uncertainty was measured using probabilistic uncertainty testing and important model assumptions were tested using univariate sensitivity testing. Results: The brief bibliotherapy intervention had an ICER of AU$8600 per DALY and the group-based psychological intervention had an ICER of AU$20 000 per DALY. The majority of the uncertainty simulations for both interventions fell below the cost-effectiveness threshold value of $50 000 per DALY. Extensive sensitivity testing showed that the results were robust to the assumptions made in the analyses. Conclusions: Following screening in general practice, both psychological interventions, particularly brief bibliotherapy, appear to be good value for money and worthy of further evaluation under routine care circumstances. Acceptability issues associated with such interventions, particularly to primary care practitioners as providers of the interventions and health system administrators, also need to be considered before wide-scale adoption is contemplated.

Learning between schools and hospitals – young people and a curriculum of (dis)connection

As noted in other papers in this volume, a group of health and education researchers and practitioners came together to further develop their understanding of the situation of young people, who were clients of The Royal Children's Hospital Education Institute in 2007 in Melbourne, Australia. The resultant research project, funded by the Australian Research Council Linkage Grant, aimed to understand young people's perspectives on who they are and what matters to them in relation to education connectedness, identity, social relationships, and experiences with professionals. The project team was aware of the persisting patterns of relationships between the hospital, schools, young people, and their families. They were also cognizant of the heavy emphasis in the research and professional literature on evidence from relevant family adults and from health and education professionals. The intention of this project was to put the young people at the centre a study with the stories they told through word and image. Identity issues and school connections framed the analytical work. Thirty-one adolescents dealing with chronic illness participated in this longitudinal qualitative study for a 3-year period of their lives. Given the apparently active role of teachers and health professionals in the lives of these young people, the researchers wanted to include the various relevant adults to see what coherence or lack of coherence existed in the categories, emphases, and values they expressed compared with those of the young people. The researchers have had to determinedly keep their focus on the data from the young people and not be seduced by the familiar and readily accessible data from these professionals. Nonetheless, this data set does provide a ‘curriculum conversation’, which is profitably read behind the stories of the young people and in the foreground of new pathways of curriculum construction. It is this data which informs the work reported in this paper and which has led the researchers to resist the rhetoric of currently held story lines in this field, to see beyond the present hierarchies of power over relevant ‘knowledges’, to maintain a dual focus with the young people at centre stage and the professionals as ‘walk ons /extras’ and to argue for a ‘curriculum of connection’ between young people and the relevant education and health professionals. These issues are readily engaged in arguments for change through the interweaving of larger discourses of inclusivity, curriculum, and policy. This paper works those intersections in the everyday positionings of professionals and young people.