Death and late-stage dementia in institutions : a cultural analysis

The first purpose of this study was to describe the deaths of fifteen nursing home residents with late-stage dementia. The devastating effect of dementia on a person has been called a ‘living death’ (Woods, 1989). The caring which occurs when someone is going through this process in a nursing home was recorded and analysed. In analysing this act of caring, the second purpose was to look for the origins of the structures and the sources of pressure that shaped the context and therefore helped determine the behaviour of the various groups under observation. These groups were residents and their relatives, the staff of the nursing home and the treating doctors. Before commencing observations and carrying out this study, an understanding needed to be developed of: the condition of dementia as it is perceived by health professionals and presented in the media; the institutions in which the majority of people with dementia end their days; the background and conditions of the staff who nurse in them; the models of care that guide and determine policies; and the conceptions of life and death which underpin relevant laws and moral standpoints. Accordingly, in part 1. chapter 1 the history, causes, pathology and effects of dementing conditions are examined. Relevant medical and lay literature including media influences are examined which pertain to the subject of death and dementia and nursing home care. The history of this institutional care is briefly examined together with the growth of the discipline of gerontological nursing. Chapter 2 discusses some of the effects of this history on present day care and the concept of emotional work being carried out within the present day aged care public policy regulations. The moral arguments surrounding illness and dying in Australian society today are briefly discussed. Chapter 3 describes the conceptual framework for the study, the ethnographic method that has been employed and an outline of critical theory as the basis for analysis. The chapter concludes by recounting the practical steps taken to arrange the field work, secure the consent of participants, record data and gather documents, and outlines the ethical considerations given to the undertaking of the study. Chapter 4 describes the context in which the study took place and the first tentative exploration of the culture from an etic perspective. Part 2 describes the death trajectories observed and raises some questions about alternative strategies that may have been considered within a different paradigm of caring. In chapter 5 the death trajectories of each of the fifteen residents in the study are described, each written with a particular emphasis to illustrate aspects of the culture of care that emerged through thematic analysis. Observations, comments and feelings from staff and family are wound in and around these case studies. Chapter 6 looks more closely at the impact of policy and institutional pressure on the milieu in which these deaths took place. Part 3 draws conclusions from the observations and makes suggestions for emancipatory change as viewed from the author's standpoint of critical ethnographic analysis. In the final chapter an argument is presented for policy change that leads a movement towards palliative care practices for people with late-stage dementia. Approaches to implementation of palliative care will need to take account of any expression by the resident such as an advanced directive, indicating a preferred approach to treatment in the period prior to death; a need for a better understanding of such issues as the significance of body breakdown, the manifestations of pain and electrolyte imbalances; the surrounding ethical complexities and shift in public opinion, and perhaps, most of ail, the culture of the institutions in which this dying will take place. A definition of late-stage dementia which might be used in determining patterns of care is set out. A discussion about changes in practice which relate lo communication with treating doctors, the administering of antibiotics, the relief of pain, the mobilisation of residents and the provision of food and water takes place in light of the evidence found. The discussion of these issues is raised in the form of debate. Each aspect needs more rigorous analysis and information so that evidence-based practice, rather than care which is value-laden and emotional, can be used when treatment decisions are made for people with late-stage dementia.

Conflict of interest in policing and the public sector

Conflicts of interest are a key factor in the contemporary decline of trust in government and public institutions, eroding public trust in government and democratic systems. Drawing on two unique empirical studies involving policing and the broader public sector, this paper explores the meaning and dimensions of conflict of interest by examining public complaints about conflict of interest and providing distinctive insights into the nature of conflict of interest as a problem for public sector ethics. The paper analyses and explores appropriate regulatory and management approaches for conflict of interest, focusing on three elements: (1) dealing with private interests that are identifiably problematic in the way they clash with the duties of public officials; (2) managing conflicts as they arise in the course of public sector work (manifested in preferential and adverse treatment, and other problematic areas); and (3) developing ethical and accountable organisational cultures. It is concluded that effective and meaningful public sector ethics in the pursuit of the public interest must be based on an ethos of social accountability and a commitment to prioritise the public interest in both fact and appearance.

Citizenship and the political institutions of cultural diversity in Australia

This thesis uses political theory to analyse and compare the Aboriginal and Torres Strait Islander Commission and the Federation of Ethnic Communities' Councils of Australia. It argues that 'self-determination' and 'multiculturalism' in practice hide the power of the Anglo-Australian dominant culture and stifle the possibilities of more viable intercultural political innovation.

English teachers' shaping of students' democratic attitudes in Taiwan

This study has several findings. English language teachers' multiple identities and 'guided democracy' educate students to be autonomous and tolerant of different cultures. A global curriculum enables students to negotiate 'Eastern' and 'Western' cultures. Communicative pedagogies have contributed to both solutions and problems. An integrated pedagogy is essential.

An examination of the range of self-funding options available to regional galleries and an assessment of their suitability for use in those institutions

Researches the suitability of a variety of self-funding options available to regional galleries in Australia. An overview of the range of current self-funding practices is given. Each option is mapped according to its impact on core/value added services and its effect on primary/secondary users and assessed for suitability using these criteria.

Do institutions, inequality and cultural differences affect cadaveric versus live-kidney harvesting

This paper empirically investigates the role of institutions, income inequality,  cultural differences and health expenditures on cadaveric versus total kidney  transplants scrutinizing information gathered from 63 countries over the period  1998-2002. We show that improvements in income equality and the rule of law encourage cadaveric kidney transplants in low-income countries. We find that cultural differences affect the number of cadaveric kidney transplants both in low- and high-income countries.

Child soldiers in the east of the Democratic Republic of Congo

According to the academic literature, the most widely used estimate is that approximately 300,000 children are part of regular and irregular armies worldwide, either as combatants or as support personnel. Moreover, most scholars believe that their numbers are growing. However, the truth is that no one really knows the actual number of child soldiers fighting in some seventy-two government or rebel forces in about twenty countries. This is simply because field work on this subject is notoriously difficult. And as it is in breach of international humanitarian law to engage a child under the age of 18 years, regular armies and guerrilla forces are hardly going to publicize the number of child soldiers in their ranks. Whatever the true number of child soldiers may be, the fact remains that child soldiers have become a principal component of military forces across Africa, Asia, and Latin America. For Africa alone, estimates suggest that there are 120,000 children, 40 per cent of all child soldiers. Moreover, not only has Africa experienced the fastest growth in the use of child soldiers, but the average age of the children enlisted in some African countries is declining as well. And this is despite the fact that there are a number of international treaties and principles that prohibit the use of child soldiers. Successfully bringing peace, security, and the rule of law in the Kivu provinces, in the Democratic Republic of the Congo (DRC), will be a massive challenge that will require domestic and regional measures implemented over probably several years. This will necessitate the continued active political and financial support of the international community.

Perceptions of representatives of public, private, and community sector institutions of the barriers and enablers for physically active transport

Active transport bridges many shared concerns in the public health and transport sectors. To positively affect opportunities for active transport, public health and transport professionals are engaging with other sectors, including urban planning, housing, recreation, retail, education, and employer groups. A first step in such inter-sectoral collaboration is to understand the perceptions of key players in all of these sectors. This paper describes the results of structured interviews with senior and middle-level administrators from public, private, and community groups in a rapidly developing region in Queensland, Australia, to assess the perceived barriers and enablers to active transport. Key themes emerged relating to infrastructure delivery, public transport services, walk- and cycle-friendly community attributes, political leadership and government coordination, and societal travel norms and culture. There were also themes relating to limits due to resources and limited relevant technical expertise, institutional and practitioner cultures, and agencies not identifying with their roles in active transport. Policies and cross-government initiatives were seen to hold promise, including economic incentives and built environment guidelines, campaigns targeting public attitudes and opinions, and community participation in policy-making. These elements are potential keys to positively promoting comprehensive active transport initiatives among gatekeepers and leaders across different sectors.

Democratic deliberation, citizenship, and networked computers

This study offers a multi-faceted response to the question of whether or not network computers can improve citizen power from the perspective of deliberative democratic theory. It concludes that in particular circumstances, computers can enhance citizens' power, and improve deliberation in liberal-democratic forums.

Australian higher education institutions transforming the future of teaching and learning through 3D virtual worlds

What are educators‟ motivations for using virtual worlds with their students? Are they using them to support the teaching of professions and if this is the case, do they introduce virtual worlds into the curriculum to develop and/or expand students' professional learning networks? Are they using virtual worlds to transform their teaching and learning? In  recognition of the exciting opportunities that virtual worlds present for higher education, the DEHub Virtual Worlds Working Group was formed. It is made up of Australian university academics who are investigating the role that virtual worlds will play in the future of education and actively implementing the technology within their own teaching practice and  curricula. This paper presents a typology for teaching and learning in 3D virtual worlds and applies the typology to a series of case studies based on the ways in which academics and their institutions are exploiting the power of virtual worlds for diverse purposes ranging from business scenarios and virtual excursions to role-play, experimentation and language development. The case studies offer insight into the ways in which institutions are transforming their teaching for an unknown future through innovative teaching and learning in virtual worlds. The paper demonstrates how virtual worlds enable low cost alternatives to existing pedagogies as well as creating opportunities for rich, immersive and authentic activities that would otherwise not be feasible or maybe not even be possible. Through the use of virtual worlds, teaching and learning can be transformed to cater for an unknown future.

Social capital, educational institutions and leadership

Social capital refers to the norms and networks that enable people to act collectively. It is a set of resources that reside in the relationships among people that allow them to share their knowledge and skills. Social capital is built and accessed through interactions between people and groups. Educational institutions and their community benefit from building social capital. Educational leaders who are committed to lifelong learning and view the community as a resource for the institution have a key role in unlocking and building social capital. Social capital is developed through a partnership process with common purpose or vision where leadership is gradually shared between institution and community.