Factors associated with the wish to hasten death : a study of patients with terminal illness

Background. There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of appropriate therapeutic interventions. Method. A sample of terminally ill cancer patients (N=256) recruited from an in-patient hospice unit, home palliative care service and a general hospital palliative care consulting service from Brisbane Australia between 1998–2001 completed a questionnaire assessing psychological (depression and anxiety), social (family relationship, social support, level of burden on others) and the impact of physical symptoms. The association between these factors and the WTHD was investigated. Results. A high WTHD was reported by 14% of patients. A discriminant function analysis revealed that the following variables were associated with a high WTHD (P<0·001): higher levels of depressive symptoms, being admitted to an in-patient hospice setting, a greater perception of being a burden on others, lower family cohesion, lower levels of social support, higher levels of anxiety and greater impact of physical symptoms. Conclusions. Psychological and social factors are related to a WTHD among terminally ill cancer patients. Greater attention needs to be paid to the assessment of psychological and social issues in order to provide appropriate therapeutic interventions for terminally ill patients.

A new educational technology for media and communication studies : mapping media in Australia and Sweden

This chapter reports on Australian and Swedish experiences in the iterative design, development, and ongoing use of interactive educational systems we call ‘Media Maps.’ Like maps in general, Media Maps are usefully understood as complex cultural technologies; that is, they are not only physical objects, tools and artefacts, but also information creation and distribution technologies, the use and development of which are embedded in systems of knowledge and social meaning. Drawing upon Australian and Swedish experiences with one Media Map technology, this paper illustrates this three-layered approach to the development of media mapping. It shows how media mapping is being used to create authentic learning experiences for students preparing for work in the rapidly evolving media and communication industries. We also contextualise media mapping as a response to various challenges for curriculum and learning design in Media and Communication Studies that arise from shifts in tertiary education policy in a global knowledge economy.

Negotiating multiple identities between school and the outside world : A critical discourse analysis

This article examines interview talk of three students in an Australian high school to show how they negotiate their young adult identities between school and the outside world. It draws on Bakhtin’s concepts of dialogism and heteroglossia to argue that identities are linguistically and corporeally constituted. A critical discourse analysis of segments of transcribed interviews and student-related public documents finds a mismatch between a social justice curriculum at school and its transfer into students’ accounts of outside school lived realities. The article concludes that a productive social justice pedagogy must use its key principles of (con)textual interrogation to engage students in reflexive practice about their positioning within and against discourses of social justice in their student and civic lives. An impending national curriculum must decide whether or not it negotiates the discursive divide any better.

Management, organisation, and ethics in the public sector

Since the 1980s, in Australia and other developed nations, public sector management philosophies and how the public sector is organized have changed dramatically. At the same time, there have been many demands, and several attempts, to preserve and promote ethical behaviour within the public sector - though few go much beyond the publication of a code. Both developments require an understanding of how public organizations operate in this new environment. Organizational and management theory are seen as providing important potential insights into the opportunities and pitfalls for building ethics into the practices, culture and norms of public organizations. This book brings together the experience and research of a range of "reflective practitioners" and "engaged academics" in public sector management, organizational theory, management theory, public sector ethics and law. It addresses what management and organization theory might suggest about the nature of public organizations and the institutionalization of ethics.

Benchmarking introductory accounting curricula : Experience from Australia

Within the context of debate about the state of accounting education in general, introductory accounting subjects have been the target of considerable criticism, particularly in terms of narrow content, technical focus, use of transmissive models of teaching, and inattention to the development of students‟ generic skills. This paper reports on the results of an exploratory study of these issues in introductory accounting and which involved the review of subject outlines and prescribed textbooks, and the conduct of a cross-sectional survey of the introductory accounting teaching coordinators in Australian universities (n=21). The primary aims of the study were to establish and apply benchmarks in evaluating existing curricula with respect to subject orientation, learning objectives, topics, teaching delivery, learning strategies, and assessment. The results of our study suggest that traditional approaches to subject content and delivery continue to dominate, with limited indicators of innovations to enhance the diversity and quality of learning experiences and learning outcomes.

Doctors and their patients : A context for understanding the wish to hasten death

There is a paucity of research that has directly examined the role of the health professional in dealing with a terminally ill patient's wish to hasten death (WTHD) and the implications of this for the support and services needed in the care for a dying patient. Themes to emerge from a qualitative analysis of interviews conducted on doctors (n=24) involved in the treatment and care of terminally ill patients were (i) the doctors' experiences in caring for their patients (including themes of emotional demands/expectations, the duration of illness, and the availability of palliative care services); (ii) the doctors' perception of the care provided to their respective patients (comprising themes concerning satisfaction with the care for physical symptoms, for emotional symptoms, or overall care); (iii) the doctors' attitudes to euthanasia and (iv) the doctors' perception of their patients' views/beliefs regarding euthanasia and hastened death. When responses were categorised according to the patients' level of a WTHD, the theme concerning the prolonged nature of the patients' illnesses was prominent in the doctor group who had patients with the highest WTHD, whereas there was only a minority of responses concerning support from palliative care services and satisfaction with the level of emotional care in this group. This exploratory study presents a set of descriptive findings identifying themes among a small group of doctors who have been involved in the care of terminally ill cancer patients, to investigate factors that may be associated with the WTHD among these patients. The pattern of findings suggest that research investigating the doctor-patient interaction in this setting may add to our understanding of the problems (for patients and their doctors) that underpins the wish to hasten death in the terminally ill.

Teacher praise and feedback and students’ perceptions of the classroom environment

The relationships between teacher praise and feedback, and students’ perceptions of the classroom environment were investigated in six rural elementary schools (n 5 747). The Teacher Feedback Scale and My Classroom Scale were developed as part of this study and used to collect the data. Structural equation modelling was used to test a hypothesised model. The results indicated that negative teacher feedback and effort feedback were both related to students’ relationships with their teachers, while ability feedback was associated with perceptions of the classroom environment. Praise was not related to classroom environment or teacher–student relationships. Significant age and gender differences were found. Additionally, differences were found between students who were satisfied with their classroom and those who were dissatisfied. Satisfied students received more general praise, general ability feedback, effort feedback and less negative teacher feedback when compared to dissatisfied students. Research studies have emphasised the influence of signicicant adults (teachers and parents) on students’ personal development (Porlier et al., 1999) and the importance of significant others’ verbal statements when directed at children (Burnett, 1996a). The relationships between negative and positive statements made by teachers, parents, peers and siblings and children’s self-talk have been investigated (Burnett, 1996a) and positive statements (praise) have been found to be more beneficial than verbal criticism (Burnett, 1999). The quality of life in the classroom in recent times has been considered of great importance to students (Thorp et al., 1994) and this is recognised by Baker (1999) who reported a relationship between students’ satisfaction with the learning environment, and differential teacher feedback and praise. This study investigated the relationships between teacher praise and feedback, and how students perceived their classroom and their relationship with their teacher.

Measuring the quality of teaching in elementary school classrooms

This paper reviews the means by which teacher quality has been measured. It considers data sources such as students, peers, experts, and examines the psychometrics and scaleproperties of teacher quality assessment instruments with respect to reliability and validity. A list of items for possible inclusion in an elementary student focussed instrument is considered, together with the potential use of such an instrument in measuring teacher quality.

Elementary school students’ learner self-concept, academic self-concepts and approaches to learning

The present study investigated the relationships between academic selfconcepts, learner self-concept, and approaches to learning in elementary school students. A sample of 580 Australian Grade 6 and 7 school students with a mean age of 10.7 years participated in the study. Weak negative correlations between learner self-concepts and surface approaches to learning were identiŽ ed. In contrast, deep approaches for both boys and girls showed the highest positive correlations with school self-concept and learning self-concept. Only slight variations in these Ž gures were found between boys and girls.

Terminally ill cancer patients’ wish to hasten death

This exploratory study investigated factors associated with the wish to hasten death among a sample of terminally ill cancer patients. Semi-structured interviews conducted on a total of 72 hospice and home palliative care patients were subjected to qualitative analysis using QSRNUDIST. The main themes to emerge suggested that patients with a high wish to hasten death had greater concerns with physical symptoms and psychologica l suffering, perceived themselves to be more of a burden to others, and experienced higher levels of demoralization, while also reporting less confidence in symptom control, fewer social supports, less satisfaction with life experiences and fewer religious beliefs when compared with patients who had a moderate or no wish to hasten death. The implications of these findings will be discussed.

Students’ perceptions of teaching and learning: the influence of students’ approaches to learning and teachers’ approaches to teaching

Nearly 500 secondary students in 24 classes were surveyed and four students in each class interviewed concerning their approaches to learning and perceptions of their classroom environment. While interviewed students with deep approaches to learning generally demonstrated a more sophisticated understanding of the learning opportunities offered to them than did students with surface approaches, teaching strategies also influenced students' perceptions. When teachers focused strongly on actively engaging students and creating a supportive environment, students with both deep and surface approaches focused on student-centred aspects of the class. In contrast, when traditional expository teaching methods were used exclusively, students with deep and surface approaches both focused on transmission and reproduction.

The study process questionnaire : a revalidation study

The Study Process Questionnaire (Biggs, 1987) has been widely used in studies investigating learning behaviours in tertiary education. Many of the studies that have used the instrument have investigated the construct validity of the SPQ using a variety of factor analytic methods and techniques in an atheoretical way. Contrary to this method, Burnett and Dart (1997) argued that the hypothesised structure of a scale should be used when assessing the construct validity of an existing instrument. This study investigated the factor structure of the SPQ using a theoretical approach and found strong support for the three approaches to learning structure of the instrument.

A naturally shaped silicone ventricle evaluated in a mock circulation loop : a preliminary study

Mock circulation loops are used to evaluate the performance of cardiac assist devices prior to animal and clinical testing. A compressible, translucent silicone ventricle chamber that mimics the exact size, shape and motion of a failing heart is desired to assist in flow visualization studies around inflow cannulae during VAD support. The aim of this study was therefore to design and construct a naturally shaped flexible left ventricle and evaluate its performance in a mock circulation loop. The ventricle shape was constructed by the use of CT images taken from a patient experiencing cardiomyopathic heart failure and used to create a 3D image and subsequent mould to produce a silicone ventricle. Different cardiac conditions were successfully simulated to validate the ventricle performance, including rest, left heart failure and VAD support.