An insight into implementing person-centred active support

This paper provides reflections on the implementation of an active support staff training programme for staff working in community residential facilities for adults with an intellectual disability. Outcomes for the people with an intellectual disability were consistent with recent research findings indicating that active support can lead to improved opportunities for participation in everyday activities within the home. We propose that the success of the training programme was largely influenced by three key elements: ensuring that there is expertise in, and support for, this approach to service provision among key service managers, provision of in vivo one-to-one practical staff training in addition to classroom-based theoretical input, and inclusion of elements of person-centred planning approaches in combination with active support. Future research should focus on how best to maximise the effectiveness of active support staff training.

Translating person-centered care into practice: a comparative analysis of motivational interviewing, illness-integration support, and guided self-determination

OBJECTIVE: Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided self-determination [GSD]. METHODS: Comparative analysis included eight components: (1) philosophical origin; (2) development in original clinical setting; (3) theoretical underpinnings; (4) overarching goal and supportive processes; (5) general principles, strategies or tools for engaging peoples; (6) health care professionals' background and training; (7) fidelity assessment; (8) reported effects. RESULTS: Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses on managing ambivalence. IIS and GSD were based on grounded theories, and MI was intuitively developed. All apply processes and strategies to advance professionals' communication skills and engagement; GSD includes context-specific reflection sheets. All offer training programs; MI and GSD include fidelity tools. CONCLUSION: Each approach has a primary application: MI, when ambivalence threatens positive change; IIS, when integrating newly diagnosed chronic conditions; and GSD, when problem solving is difficult, or deadlocked. PRACTICE IMPLICATIONS: Professionals must critically consider the context in their choice of approach.

Tackling disadvantage through student-centred learning - exploring 'Worlds of Work' in the Melbourne CBD

As the educational landscape increasingly mirrors deepening socio-economic cleavages within Australian society, the disparity in educational outcomes has been identified as one of the biggest challenges confronting secondary schooling. In contrast with most OECD countries, family background remains the most important determinant of educational achievement in Australia. More and more, schools are defined by location, reinforcing what has been dubbed the 'circular pattern of disadvantage'. At the same time, recognition of strong links between outcomes, socio economic status and location has elicited growing calls for systematic redefining of learning experiences and the public education framework. Focus on flexible, rigorous, community-oriented, person-centred learning opportunities has predicated multiple mentoring and youth schemes and has guided policy. Recognition of the need to re-engage Year 9 and 10 students underpinned development of VELS, for instance; it has also directed the programming priorities of Education Foundation Australia (EFA). This paper will discuss first, how schools perceive the programs have made a difference to both individual students and the curriculum offered in the schools, and second, how the experiences and activities provided through the program have changed the expectations and aspirations that many of the participants have in regard to how they perceive their future, their engagement with school and their careers. Both City Centre and Worlds of Work (WOW) program have received a very positive student response to real world activities that have demonstrably enhanced the development of reflective processes, interpersonal and social skills and social networks. Practical outcomes have included self-organised work experience, the development of mentor relationships and the re-engagement of some students with the schooling process. Interview data confirmed EFA's assessment that its programs have greatest impact when integrated into a school's curriculum rather than as "stand alone" electives.

Inclusion and accountability: communications research with consumers with disabilities

Over the past two decades there has been an increasing focus on doing research with and for consumers rather than on consumers. Research that is collaborative and inclusive has been called for by people with disabilities. People with disabilities are a group of telecommunications consumers who are disadvantaged because of social barriers and access issues with equipment, services and information. In this paper, the benefits and challenges of collaborative (e.g. participatory, participatory action, emancipatory) research with these consumers and the processes that can facilitate inclusive and accountable research outcomes are addressed. Throughout the paper, four questions will be explored: Who determines which research issues are explored and the methods that are used? What is the level of consumer involvement in the research process? How can academics and government ensure that consumer-focused research is inclusive and participatory? How, and to whom, should research results be made available?

In the first part of the paper, the perspectives on consumer research by people with disabilities are presented. Respect for and appreciation of consumers' views underpins the philosophical stance needed by researchers and funding bodies before serious engagement in empowering, person-centred research can be successful.

In the second part of the paper, there is a focus on defining the features of collaborative research approaches. Participatory research, participatory action research, and emancipatory research are variations that incorporate differing levels of consumer involvement. Each of these, however, embrace shifts in philosophy and methods away from more traditional 'scientific' research. Such changes result in a greater sense of inclusion and project ownership by consumers.

The third part of the paper addresses some of the issues associated with collaborative research for consumers with disabilities, for academic researchers, and for government funding bodies. Differing understandings of the social nature of disablement influence attitudes toward consumer involvement and are demonstrated in the choice of research questions, project aims, and the methodologies used. Differing agendas are reflected in reactions to the traditional project requirements and processes of government, the preferred research methodologies of researchers, and the perceived accountability of researchers or government for the dissemination and sharing of research results. The challenges to successful engagement with consumers in collaborative research have been identified in the literature and a number of strategies recommended (Barnes, 2003; Clear, 1999; Mercer, 2002; Oliver, 1992, 1997; Zarb, 1997). Application of inclusive strategies by researchers and funding bodies is essential for positive change and inclusive, empowering outcomes.

The paper concludes with a case study of a DCITA-funded research project. The project is evaluated using participatory/emancipatory research criteria modified from Zarb (1992) and addresses consumer, researcher, and funding body participation. The four questions used in the discussion of the paper are applied to this particular project. In addition, the benefits and learnings from the project will be compared with the outcomes desired by consumers who espouse collaborative research approaches.

The tri-focal model of care : Advancing the teaching-nursing home concept

Providing residential aged care is challenging because of the complexity of residents' health status, difficulties recruiting and retaining skilled staff, and financial and regulatory constraints. This paper discusses some of these challenges and describes an innovative model of care, termed 'The Tri-focal model of care'. This model was developed based on the concepts of 'partnership-centred care', 'positive work environment' and the need for evidence-based practice to underpin all aspects of care. It is envisaged that the implementation of this model will provide a rich learning environment that advances the teaching-nursing home concept and the quality of residential aged care.

Living with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND) : decision-making about 'ongoing change and adaptation

Aims and objectives. To present a model that explicates the dimensions of change and adaptation as revealed by people who are diagnosed and live with amyotrophic lateral sclerosis/motor neurone disease.

Background. Most research about amyotrophic lateral sclerosis/motor neurone disease is medically focused on cause and cure for the illness. Although psychological studies have sought to understand the illness experience through questionnaires, little is known about the experience of living with amyotrophic lateral sclerosis/motor neurone disease as described by people with the disease.

Design. A grounded theory method of simultaneous data collection and constant comparative analysis was chosen for the conduct of this study.

Methods. Data collection involved in-depth interviews, electronic correspondence, field notes, as well as stories, prose, songs and photographs important to participants. QSR NVivo 2® software was used to manage the data and modelling used to illustrate concepts.

Findings. Participants used a cyclic, decision-making pattern about 'ongoing change and adaptation' as they lived with the disease. This pattern formed the basis of the model that is presented in this paper.

Conclusion. The lives of people living with amyotrophic lateral sclerosis/motor neurone disease revolve around the need to make decisions about how to live with the disease progression and their deteriorating abilities. Life decisions were negotiated by participants to maintain a sense of self and well-being in the face of change.

Relevance to clinical practice. The 'ongoing change and adaptation' model is a framework that can guide practitioners to understand the decision-making processes of people living with amyotrophic lateral sclerosis/motor neurone disease. Such understanding will enhance caring and promote models of care that are person-centred. The model may also have relevance for people with other life limiting diseases and their care.

Responding to the ageing profile of emergency department patients

Background
Older people with acute superimposed on chronic health problems are becoming a core aspect of emergency department (ED) caseload. This project explored the ED experience from the perspective of older patients and their carers.

Method
A convenience sample of thirty participants was recruited across three participating EDs: tw o metropolitan and one regional. The project utilised two approaches to data collection: 1) an observation approach where a project officer observed participants from the time of ED presentation until discharge, or for up to six hours; and 2) a subsequent interview was conducted with the participant and their carer within a week of the ED presentation. Data from both sources were integrated, and independently thematically analysed by two members of the team.

Results
Thirty participants aged over 65 were recruited. Their average age was 77.1 (sd=6.7) years, 59% w ere female, and 74% were triage category 1- 3 (indicating moderate/high acuity). Participants spent on average 7 hours 47 minutes in the ED, with 50% discharged home, 43% admitted to general wards or MAPU, and 7% discharged to residential care/hospice. Key themes in the factors influencing the patient experience and examples of quality care were identified, along with opportunities to improve the capacity for EDs to be “older person friendly”, and “person-centred.” Challenges include improving the effectiveness of communication between staff and patients/carers (including issues around people from culturally and linguistically diverse backgrounds), availability of allied health professionals to assist with discharge planning, and a tendency for older people not to seek ED care until the health problem was severe. Patient exemplars highlight key themes.

Discussion and implications
Results of the project highlight positive aspects of emergency department care for older people and inform targets for improvement strategies. These can be used to drive ongoing improvements in care for older people presenting to EDs.

Knowledge-in-practice in the caring professions : multidisciplinary perspectives

Contents:  Ideas of knowledge in practice / Struan Jacobs -- Information, knowledge, and wisdom in medical practice / P. B. Greenberg -- The practice of the psychiatrist / Alex Holmes -- Social work knowledge-in-practice / Heather D'Cruz -- Disability : a personal approach / Lisa Chaffey -- Knowledge in the making : an analytical psychology perspective / Joy Norton -- Knowledge to action in the practice of nursing / Alison Hutchinson, Tracey Bucknall -- The risky business of birth / Frances Sheean and Jennifer M. Cameron -- Skills for person-centred care : health professionals supporting chronic condition prevention and self-management / Sharon Lawn and Malcolm Battersby -- Knowledge and reasoning in practice : an example from physiotherapy and occupational therapy / Megan Smith ... [et al.] -- Using knowledge in the practice of dealing with addiction : an ideal worth aiming for / Peter Miller.

Situationist outdoor education in the country of lost children

This thesis is a study of outdoor education, in the deliberative tradition of curriculum inquiry. It examines the intentional generation and distribution of knowledge, beliefs, and attitudes through organised outdoor activities, both as a research interest, and as a critical perspective on outdoor education discourse. Eight separate but interrelated research projects, originally published in 11 refereed journal articles, develop and defend the thesis statement: The problem of determining what, if any, forms of outdoor experience should be educational priorities, and how those experiences should be distributed in communities and geographically – that is who goes where and does what – is inherently situational. The persistence of a universalist outdoor education discourse that fails to acknowledge or adequately account for social and geographic circumstances points to serious flaws in outdoor education research and theory, and impedes the development of more defensible outdoor education practices. The introduction explains how the eight projects cohere, and illustrates how they may be linked using the example of militaristic thinking in outdoor safety standards. Chapters 1 and 2 defend and elaborate a situationist approach to outdoor education, using the examples of outdoor education in Victoria (Australia), and universalist approaches to outdoor education in textbooks respectively. Chapters 3 and 4 expand on some epistemological implications of the thesis and examine, respectively, the cultural dimensions of outdoor experience, and the epistemology and ontology of local natural history. Chapters 5 and 6 apply a situationist epistemology to personal development based outdoor education. Traditions of outdoor education that draw on person-centred rather than situation-sensitive theories of behaviour are examined and critiqued. Alternatives to person-centred theories of outdoor education are discussed. Chapters 7 and 8 use situationist outdoor education to provide a critical reading of nature-based tourism. Chapters 9, 10, and 11 return to the theme of safety in the introduction and Chapter 1, and examine the safety implications of a situationist epistemology. Closing comments briefly draw together the conclusions of all of the chapters, and offer some directions for future outdoor education research.