Pratiques traditionnelles chez les sages-femmes autochtones du Nunavik et programme de formation

Les communautés inuites de la Baie d’Hudson au Nunavik (Québec) se distinguent des autres communautés autochtones par leur réappropriation des naissances depuis 1986 et par la création d’un programme de formation de sages-femmes locales. Cela a permis de mettre un terme à une longue période de transfert des femmes pour accouchement en structure hospitalière, à des kilomètres de leur village. De plus, ce programme a pour objectif de réintégrer les pratiques traditionnelles au sein d’une obstétrique moderne afin d’offrir aux femmes des services de qualité et culturellement appropriés. Le but de notre étude était d’établir si le programme de formation de sages-femmes autochtones du Nunavik a permis de concilier ces deux approches d’enseignement différentes : l’une axée sur le savoir traditionnel, et l’autre concernant les normes de qualité de soins à respecter. Une méthode de recherche qualitative a été adoptée et les données ont été recueillies à l’aide d’entrevues réalisées auprès de cinq sages-femmes inuites et de six étudiantes sages-femmes du programme de formation du Nunavik, au sein des trois villages de la Baie d’Hudson pourvus de centre de naissances. L’analyse qualitative des données ne permet pas de confirmer la réintégration du savoir traditionnel dans la pratique des sages-femmes autochtones. Les résultats révèlent, en effet, une rareté des pratiques traditionnelles connues et/ou utilisées par celles-ci (notamment l’utilisation de plantes ou de remèdes médicinaux, les postures d’accouchement, les manœuvres obstétricales, etc) en relation avec la période périnatale. Les croyances ou codes de conduite à respecter pendant la grossesse semblent bénéficier d’une meilleure transmission, mais ne font plus l’unanimité au sein des communautés. Concernant le volet de l’obstétrique moderne, le programme de formation semble conforme aux exigences actuelles occidentales, étant reconnu par l’Ordre des sages-femmes du Québec depuis septembre 2008. De plus, les sages-femmes et les étudiantes sont conscientes de la nécessité de recevoir une formation de qualité. Elles aimeraient bénéficier d’une plus grande rigueur dans l’enseignement théorique ainsi que d’une meilleure continuité du processus d’apprentissage. La difficulté retrouvée dans la mixité de l’enseignement de ces deux savoirs (traditionnel et moderne) semble donc être liée plus particulièrement au savoir traditionnel. Les sages-femmes et étudiantes inuites souhaitent protéger et promouvoir leur patrimoine culturel, mais plus dans une optique de responsabilité communautaire que dans le cadre d’un programme de formation. Une collaboration entre les volontés des communautés concernant la réintégration de ce patrimoine et la réalité actuelle de la biomédecine demeure primordiale pour continuer à garantir la sécurité et la qualité des services dispensés.

Is more better? The relationship between outcomes achieved by problem gamblers and the number of counselling sessions attended

This paper addresses the question of how much intervention is necessary for the effective treatment of problem gambling by exploring the relationship between the number of counselling sessions attended and the degree of problem resolution achieved for 613 individuals who attended problem gambling counselling services in Victoria. While those who achieved partial or full resolution of presenting problems attended more sessions than those who finished counselling with their problems still unresolved, problems were typically reported as being resolved in fewer than five sessions. It is concluded that for some problem gamblers a relatively brief intervention may be sufficient.

The politics of resistance to workplace cultural diversity education for health service providers : an Australian study

This qualitative study has as its focus an exploration of health service providers' perceptions and experiences of the processes and implications of delivering workplace cultural diversity education for staff. Data were obtained from conducting in-depth individual and focus group interviews with a purposeful sample of 137 healthcare professionals, recruited from over 17 different organizational sites. Participants included cultural diversity educators, ethnic liaison officers, health service managers, nurses, health interpreters, allied health professionals, and community-based ethnic welfare organization personnel working in or with select metropolitan health services in Victoria, Australia. Analysis of the data revealed that workplace cultural diversity education in healthcare is a significant site of resistance and struggle. 'Resistance' was expressed in several forms including: the problematization of resources and staff availability to attend cultural diversity education forums; indifferent failure to recognize cultural imperatives in healthcare; deliberate refusal to recognize cultural imperatives in healthcare; selective recognition of cultural imperatives in healthcare ('facts sheets' only); and the angry rejection of cultural imperatives in healthcare. 'Struggle', in turn, largely involved cultural diversity educators having to constantly 'cajole and convince' (and even manipulate) staff to attend cultural diversity education forums and using a 'velvet glove and iron fist' approach to teaching staff who remained resolute in their resistance when participating in educational forums. An important implication of this study is that the politics of workplace cultural diversity education - and the 'politics of resistance' to such programs - need to be better recognized and understood if the status quo is to be successfully challenged and changed. The need for critical debate and further comparative research on the subject are also highlighted.

Study of the Geelong Local Learning and Employment Network

In common with many Western nations, Australian governments, both state and federal, have increasingly embraced network-based approaches in responding to the effects of globalisation. Since 2001, thirty one Local Learning and Employment Networks (LLEN) have been established across all areas of Victoria, Australia in line with recommendations of a Ministerial Review into Post Compulsory Education and Training Pathways. That review reported that, in the globalised context, youth in transition from schooling to independence faced persistent and severe difficulties unknown to previous generations; it also found problems were frequently concentrated in particular groups and regions. LLEN bring together the expertise and experience of local education providers, industry, community organisations, individuals and government organisations. As a result of their local decisions, collaboration and community building efforts it is intended that opportunities for young people will be enhanced. My research was conducted within an Australian Research Council Linkage Project awarded to Deakin University Faculty of Education in partnership with the Smart Geelong Region LLEN (SGR LLEN). The Linkage Project included two separate research components one of which forms my thesis: a case study of SGR LLEN. My data was generated through participant observation in SGR LLEN throughout 2004 and 2005 and through interviews, reflective writing and archival review. In undertaking my analysis and presenting my thesis I have chosen to weave a series of panels whose orientation is poststructural. This approach was based in my acceptance that all knowledge is partial and fragmentary and, accordingly, researchers need to find ways that highlight the intersections in and indeterminacy of their empirical data. The LLEN is -by its nature as a network -more than the contractual entity that gains funding from government, acts as the administrative core and occupies the LLEN office. As such I have woven firstly the formation and operational structure of the bounded entity that is SGR LLEN before weaving a series of six images that portray the unbounded LLEN as an instance-in-action. The thesis draws its theoretical inspiration from the work of Deleuze and Guattari (1987). Despite increased use of notions of networks, local decision-making and community building by governments there had been little empirical research that explored stakeholder understandings of networks and their role in community building as well as a lack of theorisation of how networks actually ‘work.’ My research addresses this lack and suggests an instituted network can function as a learning community capable of fostering systemic change in the post compulsory education training and employment sector and thereby contributing to better opportunities for young people. However the full potential of the policy is undermined by the reluctance of governments to follow through on the implications of their policies and, in particular, to confront the limiting effects of performativity at all levels.

Vision and rationalisation : a study of the school psychology profession within the Victorian Government school system

Since its origins in the 19th century, modern schooling has been a continuously contested domain within nation states. Underlying this contestation dynamic lie competing value systems about the social purpose of education; competing values around which are generated different discourses, and which in turn generate inherently contradictory social and organisational structures. As reflected in other areas of society, the 20th century expansion of state-provided schooling has essentially developed around variations of a bureaucratic model Thus, organisational cultures based around bureaucratic values have come to permeate the enterprise of schooling on a world wide scale. Concomitantly, the value for education to be fundamentally associated with human emancipation from psychological, social, political, or economic states of being, persists as a recurring theme in modern schooling. Premised on these understandings, the thesis argues that the development of the practices of school psychology as a profession, like education in general, and special education in particular, has similarly been influenced by tensions between different and competing constellations of values. It is argued that throughout the 20th century, the pervasiveness of formal schooling systems suggest that schooling may be understood as a modernist cultural archetype. As a socially constructed reality, the phenomenon of schooling has become unproblematic the apparent cultural inevitability of formal schooling in the modern era can also be understood as a premise of a systemised way of looking at the world; that of bureaucratic consciousness. Dialectically, bureaucratic consciousness persists in influencing every manifestation of schooling; structurally through its organisational forms, and epistemologically through the institutionalization of teaching and learning. A particular illustration of the dialectical relationship between bureaucratic consciousness and the social forms and social practices of schooling is the school psychology profession which has developed as a part of school systems. The thesis argues that the epistemic archeology of psychology as a knowledge discipline can be traced through an earlier European intellectual and cultural tradition, but in the 20th century, has come to develop a symbiotic yet contradictory relationship with compulsory schooling in the modern nation state. The research study employs historical and fieldwork methods in a study of the development of the school psychology services within the Victorian Education Department, particularly between 1947 and 1987. The thesis also draws upon several usually distinct literatures; the philosophical and theoretical discourse of modernity and post modernity, the history and development of modern schooling, the ethnography of schooling, the international comparative literature on the school psychology profession, and the literature on action research in education practice and curriculum development, As a case study of Victorian school psychology, the research eschews a quantitative statistical approach in favour of qualitative investigatory genres, which have in turn been guided by the values of action research in education, as well as those of critical theory. The important focus of the thesis is its investigation of some aspects of the development and transformations within the Victorian state education bureaucracy, and the dialectical relationship that has persisted between the evolution of change processes and the shifting conceptions of school psychology practices in the 20th century. A history of the organisational development of school psychology services in Victoria constitutes an important part of the thesis. This is complemented by specific illustrations of how some school psychologists have been influenced by and have contributed towards paradigm shifts within the profession, shifts relating to how the changing nature of their work practices have come to be understood and valued by teachers and by school administrators. The work of J. R. MacLeod from the 1950s is noted in this regard. Particular attention is also drawn to the dialectical relationship between bureaucratic consciousness and school psychology's professional orientation in the 1980s. As a means of providing field data to explore this relationship, ethnographic case studies with two school communities are included as part of the fieldwork of the thesis, and are based upon the author's own work in the mid 1980s. These case studies provide a basis for conceptually refraining the school psychologist's professional experience within schooling systems, and an opportunity to examine how competing value systems impact upon the work of the school psychologist. The thesis concludes with some observations about bureaucratic transformations within educational organisations, and about the future relationship of the school psychology profession with schooling systems, as framed by the theoretical parameters of the modernist /post modernist debate. The issue of competing value systems within the administration of public education is re-examined as is the value of promoting human empowerment in the ongoing work of the school psychologist. Finally, some scenario building with reference to the future of school psychology in Victoria in is undertaken.

Development of benchmarks for determining infrastructure needs for the aged

This project developed benchmarks and benchmarking procedures to indicate the current and future infrastructure requirements of the aged in regional centres. The benchmarks correlate the infrastructure requirements of the aged with demographic trends. The research also modelled aged infrastructure requirements within the broader context of the sustainability of cities.

Hope of education : Somali families and social connection

This thesis examines Somali parents' experience of their children's education after settling in Melbourne following the outbreak of civil war in Somalia in 1991. The research found that Somali parents instigate connections with teachers to generate social capital to enhance their children's education.

Evaluation of individual program plan content and quality in a Victorian residential service

The study assesses the quality and content of Individual Program Plans for 284 Victorian adults with profound intellectual disabilities living in one residential service. A checklist was developed for improving plan quality, and measurement difficulties with checklists discussed. Recommends that a quality improvement process be implemented.

Invoice methodology

An innovative method for measuring the impact of an environmental food service intervention on the nutritional quality of the food supply was developed and implemented at five food services in Victoria as part of a Catering Improvement Program trial. This study used the invoice data to investigate changes in food supply at these food services.

Caring for mentally ill relatives in rural Australia : a hermeneutic study

Ten people from an area of rural Australia recalled how they viewed caring for a mentally ill relative. Hermeneutic analysis of this material highlighted these carers' roles and learning experiences, interactions with health professionals, the stigma they experienced, their stories and language they used, and their perspectives on the future.

Do high-risk medicines alerts influence practice?

Background: Medicine-related adverse events are prevalent, costly and mostly preventable. The High Risk Medicines Working Party (Victoria) developed and distributed three highrisk medicines alerts – wrong route of administration of oral medicines, subcutaneous insulin and unfractionated heparin – and accompanying audit tools in 2008 and 2009.
Aims: To determine the impact of the three high-risk medicines alerts on Victorian health services; to assess the clinical relevance and utility of the audit tools; to identify barriers to implementing recommendations; and to obtain feedback and suggestions for future alert topics.
Method: A cross-sectional survey was undertaken from 6 to 31 July 2009 using an online questionnaire. The questionnaire was distributed to 90 metropolitan, regional and rural public health services in Victoria and approximately 200 members of the Quality Use of Medicines Network (Victoria).
Results: Most of the 90 respondents were pharmacists (53%) and nurses (31%). 53 (59%) respondents reported making changes as a result of receiving the high-risk medicines alerts – 21 (40%) concerned the wrong route of administration, 12 (23%) subcutaneous insulin and 7 (13%) unfractionated heparin. Barriers to implementation included time constraints, inadequate staff and resources, excessive paperwork and competing priorities. A minority of respondents indicated some alerts were not relevant to small rural services. Suggestions for
improving the audit tools included making them less labour intensive, enabling electronic responses and ensuring their distribution is coordinated with other medicine-related tools.
Conclusion: High-risk medicines alerts and the accompanying audit tools facilitated change but there were some barriers to their implementation, such as time and resource constraints. Not all alerts and audit tools were relevant to all health services.