Medical education and law: Withholding/withdrawing treatment from adults without capacity

BACKGROUND Law is increasingly involved in clinical practice, particularly at the end of life, but undergraduate and postgraduate education in this area remains unsystematic. We hypothesised that attitudes to and knowledge of the law governing withholding/withdrawing treatment from adults without capacity (the WWLST law) would vary and demonstrate deficiencies among medical specialists. AIMS We investigated perspectives, knowledge and training of medical specialists in the three largest (populations and medical workforces) Australian states, concerning the WWLST law. METHODS Following expert legal review, specialist focus groups, pre-testing and piloting in each state, seven specialties involved with end-of-life care were surveyed, with a variety of statistical analyses applied to the responses. RESULTS Respondents supported the need to know and follow the law. There were mixed views about its helpfulness in medical decision-making. Over half the respondents conceded poor knowledge of the law; this was mirrored by critical gaps in knowledge that varied by specialty. There were relatively low but increasing rates of education from the undergraduate to continuing professional development (CPD) stages. Mean knowledge score did not vary significantly according to undergraduate or immediate postgraduate training, but CPD training, particularly if recent, resulted in greater knowledge. Case-based workshops were the preferred CPD instruction method. CONCLUSIONS Teaching of current and evolving law should be strengthened across all stages of medical education. This should improve understanding of the role of law, ameliorate ambivalence towards the law, and contribute to more informed deliberation about end-of-life issues with patients and families.

Education in stroke prevention: Efficacy of an educational counselling intervention to increase knowledge in stroke survivors

BACKGROUND Motivational interviewing and stages of change are approaches to increasing knowledge and effecting behavioural change. This study examined the application of this approach on stroke knowledge acquisition and changing individual lifestyle risk factors in an outpatient clinic. METHODS RCT in which 200 participants were allocated to an education-counselling interview (ECI) or a control group. ECI group participants mapped their individual risk factors on a stage of change model and received an appointment to the next group lifestyle class. Participants completed a stroke knowledge questionnaire at baseline (T1), post-appointment, and three months (T3) post-appointment. Passive to active changes in lifestyle behaviour were self-reported at three months. RESULTS There was a statistically significant difference between groups from T1 toT3 in stroke knowledge (p < 0.001). While there was a significant shift from a passive to active stage of change for the overall study sample (p < 0.000), there was no significant difference between groups on the identified risk factors. CONCLUSIONS Although contact with patients in ambulatory clinical settings is limited due to time constraints, it is still possible to improve knowledge and initiate lifestyle changes utilizing motivational interviewing and a stage of change model. Stroke nurses may wish to consider these techniques in their practice setting.

Education policy-making and time

This paper examines the global policy convergence toward high-stakes testing in schools and the use of test results to ‘steer at a distance’, particularly as it applies to policy-makers’ promise to improve teacher quality. Using Deleuze’s three syntheses of time in the context of the Australian policy blueprint Quality Education, this paper argues that using test scores to discipline teaching repeats the past habit of policy-making as continuing the problem of the unaccountable teacher. This results in local policy-making enfolding test scores in a pure past where the teacher-as-problem is resolved through the use of data from testing to deliver accountability and transparency. This use of the database returns a digitised form of inspection that is a repetition of the habit of teacher-as-problem. While dystopian possibilities are available through the database, in what Deleuze refers to as a control society, for us the challenge is to consider policy-making as a step into an unknown future, to engage with producing policy that is not grounded on the unconscious interiority of solving the teacher problem, but of imagining new ways of conceiving the relationship between policy-making and teaching.

Postprocedural effects of gastrointestinal endoscopy performed as a day case procedure in children : implications for patient and family education

A prospective design that included a survey tool, nursing care records, and telephone interview was used to determine postprocedural effects experienced by children and families following gastrointestinal endoscopy performed as a day procedure. One hundred twenty-one children attending a pediatric gastroenterology unit for endoscopy under general anesthesia participated in the study. Physical symptoms, day care/school attendance, behavioral issues, and economic factors in the 72 hours post procedure were identified. Over half the children (n = 69, 57%) experienced pain in the hospital post procedure. Pain was reported by 73 children (60%) at home on the day of the procedure, by 55 children (45%) on Day 1 post procedure, and by 37 children (31%) on Day 2 post procedure. The throat was the most common site of pain. Nausea or vomiting was experienced by 37 children (31%) at some time following their procedure but was not associated with procedure type, age, or fasting time. Over half the children (n = 53, 51%) who usually attended day care or school did not attend the day following their procedure. Twenty-four parents (40%) who would normally have worked on the day after the procedure did not attend employment. These findings have been used to improve the preprocedural information and discharge management of patients treated in a pediatric gastroenterology ambulatory setting. © The Society of Gastroenterology Nurses & Associates 2007. All Rights Reserved.

Preventive Dentistry and Dental Education in Iran

The present study investigated the preventive orientation of the dental education system in Iran as reflected in the responses of dental school educators and dental students to a questionnaire survey. Two questionnaires, one for dental school educators and one for senior dental students, were designed and piloted. Of the 15 state dental schools in Iran, 7 were selected using a multi-stage sampling approach, and all the dental school educators and senior dental students in these schools were asked to voluntarily fill in the anonymous questionnaires. Totally, 291 educators (80%) and 270 students (82%) participated in the study. In addition to background information, both questionnaires requested information on knowledge of caries prevention, attitudes towards preventive dentistry and oral health behaviour of the respondents. The students' questionnaire also covered items concerning prevention-oriented practice, study motives, and career preferences. Contrary to knowledge and attitudes of the students, those of the educators' were positively associated with some of their academic and personal background characteristics. Women were more likely to report favourable oral self-care habits than men. The other determinants of oral health behaviour were educators' familiarity with the oral public health field, and students' attitudes towards prevention. A higher score on preventive practice among the students was associated with better oral self-care habits and positive attitudes towards prevention. Characteristics of the profession and social status and security were the top-ranked that motivated students to study dentistry, and students mainly preferred to enter postgraduate courses and private practice after graduation. To increase the orientation of Iran's health care system towards prevention, and to cope with current concepts of prevention, corresponding changes should be made in the dental education system. The results of this study support the revision of the dental curriculum by placing more emphasis on prevention-related topics and by integrating prevention-related concepts into all disciplines. Additionally, practicing dentists and dental educators should be provided with opportunities to attend continuing education courses and to conduct seminars and congresses on various aspects of preventive dentistry at home as well as abroad.

Cultural safety and diversity: Refocusing our energies in mental health nursing practice, education and research

INTRODUCTION AND BACKGROUND: This presentation draws on a body of work assessing cultural safety's potential to generate change in mental health nursing research (Cox and Simpson 2015), in education and in clinical practice (Cox and Taua 2013, 2016; Happell, Cowin, Roper, Lakeman & Cox 2013). It presents evidence to suggest that cultural safety could resolve the conceptual confusion surrounding culture and diversity in nursing curricular, in clinical and in research practice. The history and nature of mental health work recommend cultural safety to focus attention on diversity, power imbalance, racism, cultural dominance, and structural inequality, identified as barriers and tensions in clinical practice and in service user participation. Cultural safety gives mental health nursing a well theorized and articulated model, which is evolving to improve practice into the future. DESCRIPTION: This work involved an immersion in the literature on cultural safety and the Service User Research movement. It draws on 5 months' work with a service users' research group in the UK and reflections on 9 years of cultural safety teaching. POLICY/PRACTICE CHANGE: This work provokes a crucial change of emphasis from locating the source of issues in the diversity of people to locating it in how society responds to diversity: a change from individualistic to systemic concerns. IMPLICATIONS FOR MENTAL HEALTH NURSING: Cultural safety in clinical practice, education, and research is specifically concerned with awareness of the impact of systemic workplace cultures and with staff cultural self-awareness to bring about cultural change and person-centred care of individuals' unique needs and aspirations within their life context.

Moving beyond the business plan in enterprise education

Purpose The purpose of this paper is to approach the debate surrounding the role of business plans in enterprise/entrepreneurship education from a different perspective; that of the student. The paper argues that much of the consternation within this stubborn debate derives from a lack of appreciation of the context actually occurring in the lives of our students. The paper aims to explore several arguments directly related to these contexts. Design/methodology/approach The approach is to build around a combining of cycles of reflective practice via the authors' iterative consultation with each other. The paper seeks to explore the world of the student via an enfolding of the literature, but ultimately we do not claim to have hidden our personal biases. Findings It is important to separate enterprise education (EE) from entrepreneurship education when discussing the role of the business plan. While the business plan has a place in the latter, it makes little sense for it to be a focal learning activity in the former. In addition, we see this outcome as a positive outcome for our field with little point in continuing on with what has become a fairly pointless debate. Practical implications: The paper concludes that once EE is viewed as being distinctly different from entrepreneurship education it is free to be considered with more precision what learning needs exist. Focusing on learning needs changes the direction of the discussion, with the business plan only up for discussion if it contributes a learning activity related to pre-determined learning outcomes. Originality/value The paper offers a constructive way forward from a debate that has been beset with extreme vested interests for too long.

Interprofessional education in clinical practice: Not a single vaccine

In increasingly complex health service environments, the quality of teamwork and co-operation between doctors, nurses and allied health professionals, is 'under the microscope'. Interprofessional education (IPE), a process whereby health professionals learn 'from, with and about each other', is advocated as a response to widespread calls for improved communication and collaboration between healthcare professionals. Although there is much that is commendable in IPE, the authors caution that the benefits may be overstated if too much is attributed to, or expected of, IPE activities. The authors propose that clarity is required around what can realistically be achieved. Furthermore, engagement with clinicians in the clinical practice setting who are instrumental in assisting students make sense of their knowledge through practice, is imperative for sustainable outcomes. © AHHA 2010.

Environment Education for Ecosystem Conservation

Conservation of natural resources through sustainable ecosystem management and development is the key to our secured future. The management of ecosystem involves inventorying and monitoring, and applying integrated technologies, methodologies and interdisciplinary approaches for its conservation. Hence, now it is even more critical than ever before for the humans to be environmentally literate. To realise this vision, both ecological and environmental education must become a fundamental part of the education system at all levels of education. Currently, it is even more critical than ever before for the humankind as a whole to have a clear understanding of environmental concerns and to follow sustainable development practices. The degradation of our environment is linked to continuing problems of pollution, loss of forest, solid waste disposal, and issues related to economic productivity and national as well as ecological security. Environmental management has gained momentum in the recent years with the initiatives focussing on managing environmental hazards and preventing possible disasters. Environmental issues make better sense, when one can understand them in the context of one’s own cognitive sphere. Environmental education focusing on real-world contexts and issues often begins close to home, encouraging learners to understand and forge connections with their immediate surroundings. The awareness, knowledge, and skills needed for these local connections and understandings provide a base for moving out into larger systems, broader issues, and a more sophisticated comprehension of causes, connections, and consequences. Environmental Education Programme at CES in collaboration with Karnataka Environment Research Foundation (KERF) referred as ‘Know your Ecosystem’ focuses on the importance of investigating the ecosystems within the context of human influences, incorporating an examination of ecology, economics, culture, political structure, and social equity as well as natural processes and systems. The ultimate goal of environment education is to develop an environmentally literate public. It needs to address the connection between our conception and practice of education and our relationship as human cultures to life-sustaining ecological systems. For each environmental issue there are many perspectives and much uncertainty. Environmental education cultivates the ability to recognise uncertainty, envision alternative scenarios, and adapt to changing conditions and information. These knowledge, skills, and mindset translate into a citizenry who is better equipped to address its common problems and take advantage of opportunities, whether environmental concerns are involved or not.

Environment Education for Ecosystem Conservation

Conservation of natural resources through sustainable ecosystem management and development is the key to our secured future. The management of ecosystem involves inventorying and monitoring, and applying integrated technologies, methodologies and interdisciplinary approaches for its conservation. Hence, now it is even more critical than ever before for the humans to be environmentally literate. To realise this vision, both ecological and environmental education must become a fundamental part of the education system at all levels of education. Currently, it is even more critical than ever before for the humankind as a whole to have a clear understanding of environmental concerns and to follow sustainable development practices. The degradation of our environment is linked to continuing problems of pollution, loss of forest, solid waste disposal, and issues related to economic productivity and national as well as ecological security. Environmental management has gained momentum in the recent years with the initiatives focussing on managing environmental hazards and preventing possible disasters. Environmental issues make better sense, when one can understand them in the context of one’s own cognitive sphere. Environmental education focusing on real-world contexts and issues often begins close to home, encouraging learners to understand and forge connections with their immediate surroundings. The awareness, knowledge, and skills needed for these local connections and understandings provide a base for moving out into larger systems, broader issues, and a more sophisticated comprehension of causes, connections, and consequences. Environmental Education Programme at CES in collaboration with Karnataka Environment Research Foundation (KERF) referred as ‘Know your Ecosystem’ focuses on the importance of investigating the ecosystems within the context of human influences, incorporating an examination of ecology, economics, culture, political structure, and social equity as well as natural processes and systems. The ultimate goal of environment education is to develop an environmentally literate public. It needs to address the connection between our conception and practice of education and our relationship as human cultures to life-sustaining ecological systems. For each environmental issue there are many perspectives and much uncertainty. Environmental education cultivates the ability to recognise uncertainty, envision alternative scenarios, and adapt to changing conditions and information. These knowledge, skills, and mindset translate into a citizenry who is better equipped to address its common problems and take advantage of opportunities, whether environmental concerns are involved or not.

Environment Education for Ecosystem Conservation

Conservation of natural resources through sustainable ecosystem management and development is the key to our secured future. The management of ecosystem involves inventorying and monitoring, and applying integrated technologies, methodologies and interdisciplinary approaches for its conservation. Hence, now it is even more critical than ever before for the humans to be environmentally literate. To realise this vision, both ecological and environmental education must become a fundamental part of the education system at all levels of education. Currently, it is even more critical than ever before for the humankind as a whole to have a clear understanding of environmental concerns and to follow sustainable development practices. The degradation of our environment is linked to continuing problems of pollution, loss of forest, solid waste disposal, and issues related to economic productivity and national as well as ecological security. Environmental management has gained momentum in the recent years with the initiatives focussing on managing environmental hazards and preventing possible disasters. Environmental issues make better sense, when one can understand them in the context of one’s own cognitive sphere. Environmental education focusing on real-world contexts and issues often begins close to home, encouraging learners to understand and forge connections with their immediate surroundings. The awareness, knowledge, and skills needed for these local connections and understandings provide a base for moving out into larger systems, broader issues, and a more sophisticated comprehension of causes, connections, and consequences. Environmental Education Programme at CES in collaboration with Karnataka Environment Research Foundation (KERF) referred as ‘Know your Ecosystem’ focuses on the importance of investigating the ecosystems within the context of human influences, incorporating an examination of ecology, economics, culture, political structure, and social equity as well as natural processes and systems. The ultimate goal of environment education is to develop an environmentally literate public. It needs to address the connection between our conception and practice of education and our relationship as human cultures to life-sustaining ecological systems. For each environmental issue there are many perspectives and much uncertainty. Environmental education cultivates the ability to recognise uncertainty, envision alternative scenarios, and adapt to changing conditions and information. These knowledge, skills, and mindset translate into a citizenry who is better equipped to address its common problems and take advantage of opportunities, whether environmental concerns are involved or not.

Learning to Teach and its Implications for the Continuum of Teacher Education: A Nine Country Cross-national Study.

The purpose of this Report is to inform discussions, policy formulation, and strategic planning on teacher education in Ireland. The research gives priority to initial teacher education (ITE) and induction, their interface, and implications for the continuum of teacher education, including continuing professional development (CPD). The study involved a two-pronged approach: a narrative review of recent and relevant literature and a cross-national review of teacher education policies in nine countries, namely, Ireland, Northern Ireland, Scotland, England, Finland, USA, Poland, Singapore and New Zealand. Adopting a broad, balanced and comprehensive understanding of the role of the contemporary teacher, it provides a framework for developing quality teacher education in Ireland. The Report incorporates exemplars of good practice and notes their implementation challenges for the Irish context.  Chapter One provides a framework for conceptualising quality teacher education and the continuum. Key features that emerge from the literature are discussed: teachers¿ practice, quality teaching, the professional life-cycle, teacher learning and relationships. With more specific reference to the continuum, Chapter Two overviews initial teacher education, induction, learning outcomes and accreditation in the selected countries, including Ireland. Key features of policy in the various countries are summarised. Individual country profiles, incorporating descriptions of socio-political, teaching and teacher education contexts, are further detailed in Appendix A. Chapter Three analyses relevant literature on initial teacher education, induction, learning outcomes/professional standards and accreditation. Along with previous chapters it provides the basis for recommendations for teacher education that are presented in Chapter Four. Chapter Four draws together the findings emerging from the cross-national review in terms of the contemporary context of teacher education in Ireland and identifies key challenges and possible lines of policy development as well as recommendations for the Teaching Council and other teacher education stakeholders. Each generation has an opportunity to provide the vision and resources for renewing teacher education in light of ambitious social, economic and educational aspirations to meet perceived societal and education challenges (as occurred in the 1970s). Despite the publication of two key reviews of initial teacher education a number of years ago, there is considerable scope for further reform of teacher education. However, significant changes have occurred to teacher education course provision and content over the last 100 years. In this report, we have stressed the need for, and called for investment in, greater system and programme coherence, mentoring to support assisted practice, knowledge integration, critical reflective practice, inquiry and the development of vibrant partnerships between higher education institutions and schools as the basis for teacher education reform across the continuum. This Executive Summary presents the Report¿s context, key findings and recommendations emerging from the analysis.  

(Un)veiling desire: re-defining relationships between gendered adult education subjects and adult education programmes

My underlying argument, in this paper, is that conceptualisations of power as a commodity, through which the 'disempowered-as-illiterate' subject moves towards becoming an 'empowered-as-literate' subject, forces constructs of identities into a powerful/powerless dichotomy which does not always do justice to diverse experiences. The claimed 'empowering' intentions of adult education programme and policy practice may, in reality, contribute to the dominance of restrictive disciplining and regulatory discursive practices. Moving away from emancipatory trajectories of adult education programmes that allege only liberation from domination, through 'literacy', can promise freedom points to another position of hope. Drawing on Foucauldian analysis, I explore sites of resistance as possibilities of transforming 'structures of understanding' at different levels. Officially validated and recognised transformations, in adult education programme as well as policy understandings, of the 'illiterate' subject may also hope to include choices in postures of autonomy (see Spivak 1996) made by programme participants in other 'fields' of socio-cultural practice linked to their material realities. Subsequently, 'empowerment' of the 'illiterate Indian village woman' cannot solely be imagined as a product of laws, policies and institutional discursive practices (see, for example, Gouws 2005; Rai 2003 on gender mainstreaming and Mosse 2005 on aid policy and practice). The 'illiterate Indian village woman' represented as a site of resistance, throughout this paper, displaces homogeneous representations of the 'illiterate' which situate her in the role of 'dependent' or 'victim', as failed attempts to rob her of her historical and political agency (Mohanty 1996). Through narrating other 'images' of refusal in my ethnographic vignettes, I hope to recognise different individuals' sense of agency, at all levels, as embedded in and evolving through forms of collective action that activate differences in order to develop possibilities and sustain hope for transforming historically rooted discursive practices of inequality. I provide ethnographic accounts of resisting 'literacy' programme participants, based in different villages in Bihar (Northern India), as accounts of resistance impacted on by notions of norms, translating and interpreting Others, networks and empowerment.