Diabetes and end-of-life care: ethical issues, practices and challenges

Abstract:
Diabetes is the most significant chronic disease and the global prevalence is increasing. Diabetes is associated with debilitating long term complications and other comorbidities that cause high rates of morbidity and mortality. Keeping blood glucose and other metabolic parameters within an acceptable, personalised range is important to comfort and quality of life but can be challenging, especially during end-of-life care. Guidelines can help clinicians make appropriate care decisions; however, there is little research about what constitutes best practice diabetes care at the end-of-life: existing recommendations and guidelines blend the best available evidence with consensus opinion. In addition, there are important ethical and methodological considerations concerning research involving vulnerable people at the end-of-life. Chapter 3 describes the ethical and methodological issues that needed to be considered when developing guidelines for managing diabetes at the end-of-life and the contribution interviews with dying people and their family carers made to developing a guiding philosophy and to person-centred guidelines.

'Everybody has settled in so well': How migrants make connections and build social capital in Geelong

Australian and Victorian Government policies encourage settlement in regional areas for international migrants, refugees and internal migrants. Migrants to regional areas are diverse in terms of their area or country of origin, skills and occupation, family status and other demographic characteristics. The regional cities to which they migrate are also varied in terms of their community resources, social and cultural capital. The objective shared by all of these cities is for migrants to engage successfully with their new communities. Just how this occurs is the subject of debate and a lack of clarity. This therefore calls for a sound, theoretically informed understanding of how employers and community groups (formal and informal) can effectively assist migrants to make social connections in regional cities, and practical strategies which respond to these insights. The well-established social determinants of health tell us that the more socially included, connected and stable workforce and their families are, the better will be their physical and mental health and wellbeing.

Evidence based guidelines to improve engagement and participation for people experiencing depression

Background:
Depression can have a strongly negative impact on a person’s ability to engage with and participate in activities of daily living. Clinicians currently seeking guidance on best practice in this area currently need to access and critique a wide range of evidence from a number of disciplines. While some clinical practice guidelines are available, this form of evidence presentation presents several barriers to implementation.

Procedures:
This article proposes a new procedure for developing guidance for clinicians, known as evidence based guidelines. The purpose of the guidelines presented here is to provide guidance on appropriate assessment and intervention strategies with people experiencing depression, who wish to improve their engagement and participation in daily activities. They were constructed using a multiple methods procedure, with five phases.

Results:
Evidence based guidelines for the general population, older adults and people with co-morbid physical conditions are presented at the conclusion of this article.

Conclusion:
The procedure described here produces evidence based guidelines with built in measures to promote implementation into practice. The resulting guidelines for depression will enable clinicians from all disciplines to engage in best practice, and assist people with depression participate more fully in their lives.

Identifying and developing effective approaches to foster intercultural understanding in schools

This paper provides a systematic review of education literature focused on identifying school-based approaches for developing students’ intercultural understanding. Studies were assessed using selection criteria and then critically appraised for study quality. A key finding from the review is that developing students’ intercultural understanding beyond cultural awareness requires students and teachers to take a critical approach toward cultural diversity, as well as the opportunity for ongoing intercultural and intergroup contact. Studies reported that only building cultural awareness and knowledge is not enough to promote long-term changes in attitudes. There is a need for more rigorously evaluated longitudinal school-based interventions. Finally, studies consistently call for investment in teachers’ professional and personal intercultural capabilities. The paper concludes by calling for school-based interventions that are informed by best practice approaches at a whole school level in order to effectively develop students’ intercultural attitudes and skills.

An integrated management systems approach to corporate social responsibility

A great deal of research has emphasized the strategic management of corporate social responsibility (CSR). However, gaps remain on how CSR can be effectively integrated with existing business processes. One key question remaining is how to design business processes so that they accommodate stakeholder requirements in an integrated manner. The purpose of this paper is to present a framework that can be used to integrate CSR into business processes. The framework highlights the concept of simultaneous ‘top-down integration’ and ‘bottom-up community-related indicators development’ approaches to CSR. These two approaches are elaborated with the help of two cases. The top-down approach focuses on building CSR into existing business initiatives through an integrated management systems (IMS) approach. This paper concludes that an IMS approach provides the infrastructure for the integration of CSR. The bottom-up approach focuses on the development of indicators linked to community initiatives. Examples of best practice for both the top-down and bottom-up approaches are provided in two case studies.

A systematic review of the extent and measurement of healthcare provider racism

Background
Although considered a key driver of racial disparities in healthcare, relatively little is known about the extent of interpersonal racism perpetrated by healthcare providers, nor is there a good understanding of how best to measure such racism.

Objectives
This paper reviews worldwide evidence (from 1995 onwards) for racism among healthcare providers; as well as comparing existing measurement approaches to emerging best practice, it focuses on the assessment of interpersonal racism, rather than internalized or systemic/institutional racism.

Methods
The following databases and electronic journal collections were searched for articles published between 1995 and 2012: Medline, CINAHL, PsycInfo, Sociological Abstracts. Included studies were published empirical studies of any design measuring and/or reporting on healthcare provider racism in the English language. Data on study design and objectives; method of measurement, constructs measured, type of tool; study population and healthcare setting; country and language of study; and study outcomes were extracted from each study.

Results
The 37 studies included in this review were almost solely conducted in the U.S. and with physicians. Statistically significant evidence of racist beliefs, emotions or practices among healthcare providers in relation to minority groups was evident in 26 of these studies. Although a number of measurement approaches were utilized, a limited range of constructs was assessed.

Conclusion
Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

A critical review of psychological instruments used in police officer selection

Purpose
The purpose of this paper is to critically examine the instruments used in the screening process, with particular attention given to supporting research validation. Psychological screening is a well-established process used in the selection of employees across public safety industries, particularly in police settings. Screening in and screening out are both possible, with screening out being the most commonly used method. Little attention, however, has been given to evaluating the comparative validities of the instruments used.

Design/methodology/approach
This review investigates literature supporting the use of the Minnesota Multiphasic Personality Inventory (MMPI), the California Personality Inventory (CPI), the Inwald Personality Inventory (IPI), the Australian Institute of Forensic Psychology's test battery (AIFP), and some other less researched tests. Research supporting the validity of each test is discussed.

Findings
It was found that no test possesses unequivocal research support, although the CPI and AIFP tests show promise. Most formal research into the validity of the instruments lacks appropriate experimental structure and is therefore less powerful as “evidence” of the utility of the instrument(s).

Practical implications
This research raises the notion that many current screening practices are likely to be adding minimal value to the selection process by way of using instruments that are not “cut out” for the job. This has implications for policy and practice at the recruitment stage of police employment.

Originality/value
This research provides a critical overview of the instruments and their validity studies rather than examining the general process of psychological screening. As such, it is useful to those working in selection who are facing the choice of psychological instrument. Possibilities for future research are presented, and development opportunities for a best practice instrument are discussed.

Engaging clinicians in research: Issues to consider

The beginning of nursing research is attributed to Florence Nightingale whose research during the Crimean War in the 1850s ultimately shaped health care, including nursing practice. Modern research, like clinical care, is influenced by technological, societal, organisational and environmental changes. However, ‘nursing research’ is a simple term that may not encompass complex inter-related concepts and practices and various research methods: quantitative, qualitative, implementation science, evaluation and audit. All research methods follow a similar basic ‘research process,’ but the way the process is applied and rigor is demonstrated differs among the methods. All nurses must engage in research on some level, given they practice in a climate of evidence-based care and are expected to adhere to evidence-based protocols and guidelines. In addition, they need to be able to implement evidence-based best practice and use clinical judgement to treat each person as an individual.

Reducing stress in the workplace : an evidence review : full report

Job stress is a large and growing concern in Australia and internationally. This report presents a current snapshot on job stress concepts and measures, an overview of the evidence linking job stress to ill health, estimates of the size of the problem, the benefits of reducing job stress, a summary of the intervention research on ways to prevent and control job stress, an outline of international best practice in job stress intervention and resources for workplace stakeholders to support efforts to implement best practice.

Reducing stress in the workplace: an evidence review: summary report

Job stress is a large and growing concern in Australia and internationally. This report presents a current snapshot on job stress concepts and measures, an overview of the evidence linking job stress to ill health, estimates of the size of the problem, the benefits of reducing job stress, a summary of the intervention research on ways to prevent and control job stress, an outline of international best practice in job stress intervention and resources for workplace stakeholders to support efforts to implement best practice.

Authentically assessing graduate teaching: outside and beyond neo-liberal constructs

In this paper, we challenge the current focus on ‘best practice’, graduate teacher tests, and student test scores as the panacea for ensuring teaching quality and argue for ways of thinking about evidence of quality beginning teaching outside and beyond the current neoliberal accountability discourses circulating in Australia and other countries. We suggest that teacher educators need to reinsert themselves as key players in the debates around quality beginning teaching, rather than being viewed as a source of the problem. To enable teacher educators to assume accountability for quality beginning teachers, we propose the framework of a capstone teacher performance assessment—a structured portfolio called the Authentic Teacher Assessment (ATA)— and examine examples of these assessments through the lens of critical discourse analysis. As a measure of ‘readiness to teach’, the ATA is compared with supervising teachers’ assessments of preservice teachers. We argue that structured portfolios that include artefacts derived from preservice teachers’ practice in classrooms along with graduate teacher self assessments provide a stronger accountability measure of effec- tive beginning teaching and demonstrably address the current anxiety regarding ‘evi- dence’. We suggest that such an approach should be reliable enough to be ‘read’ by external assessors (and moderated across other teacher education institutions). Rigor- ous research on a national basis is called for in order to develop and implement a structured portfolio as rich evidence of graduates’ quality and readiness to teach.

Creating healthy food environments through global benchmarking of government nutrition policies and food industry practices

Unhealthy processed food products are increasingly dominating over healthy foods, making food and nutrition environments unhealthier. Development and implementation of strong government healthy food policies is currently being circumvented in many countries by powerful food industry lobbying. In order to increase accountability of both governments and the private sector for their actions, and improve the healthiness of food environments, INFORMAS (the International Network for Food and Obesity/non-communicable diseases (NCDs) Research, Monitoring and Action Support) has recently been founded to systematically and comprehensively monitor food environments and policies in countries of varying size and income. This will enable INFORMAS to rank both governments and private sector companies globally according to their actions on food environments. Identification of those countries which have the healthiest food and nutrition policies and using them as international benchmarks against which national progress towards best practice can be assessed, should support reductions in global obesity and diet-related NCDs.

A methodological approach to quality assurance of programs in an independent school

This paper reports on ways in which one Australian independent school seeks to develop and sustain best practice and academic integrity in its programs through a quality assurance system of ongoing program reviews, and findings of a study that we conducted into staff perceptions of the different program reviews. First, we outline the overarching methodological and conceptual approaches used in the school’s program reviews. Second, we present and discuss the findings of the study.

Towards global benchmarking of food environments and policies to reduce obesity and diet-related non-communicable diseases : design and methods for nation-wide surveys

Introduction: 

Supporting children's social development

This book shows educators how to support children’s friendships in the early years. It covers three core themes:

- knowing how young children form close relationships with each other