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.

Social justice in education in 'new times'

This thesis considers social justice in education in ‘new times’. To facilitate the investigation a number of research questions were pursued. These questions were: • What is meant by the label ‘social justice’? • How is social justice to be understood in contemporary terms? • Are there tensions between traditional and contemporary views of social justice? • How effective are policy developments in delivering social justice via education? • What difference do such policies make at the local level? To answer these questions a critical case analysis of a country community and one of its primary schools was carried out. Data were gathered using a variety of methods. As a researcher who was also a teacher in the school I kept a personal professional journal during 1993 and 1994. During this period I was the teacher in the school with responsibility for curriculum development related to issues of social justice. In 1994 I conducted interviews with twenty students, parents and teachers at the school in relation to social justice issues. I also interviewed the CEO of the town’s Council. A number of relevant Federal and State Government and school policy documents were consulted and an archival search of the local newspaper from 1956 to 1994 was undertaken. Statistical information from the Australian Bureau of Statistics as well as from school records was used. A number of local history books were consulted as well as the minutes of relevant school committee meetings. Contemporary social theory, more specifically the work of Anthony Giddens, provided the major methodological tool. Giddens structuration theory was selected as it provided a way of interpreting society from both macro and micro perspectives, it provided a way of studying the interconnectedness of the individual and society. In addition to this, a metaphor was used as a way of developing an understanding of the data. The river was chosen as the metaphor as it has significance to the case study community and it also provides a way of understanding interconnectedness. At an interpretive level, both social theory and moral philosophy were drawn on, including the work of Geoffrey Sharp, Anthony Giddens and Alisdair MacIntyre. A review of selected literature indicated three main areas of concern in relation to this thesis. We live in a time of constant and ongoing change, understanding how this change impacts on the lives of individuals and society is important. Such an understanding relates directly to issues of ontology. In addition it was necessary to consider schools in these ‘new times’. The literature revealed that the changes occurring in the wider society were related to the changes currently being seen in schools. Specifically this related to the increasing emphasis on economics and on individualism, emphases also reflected in the findings of this thesis. Finally the literature related to social justice was discussed, the focus here was on distributive theories of justice and the way these are reflected in programs such as the DSP. The data, as expressed in the metaphor of the flowing river, revealed dominant and marginal currents in social justice in education in ‘new times’. The dominant social group are the intellectually trained and the dominant issues were related to technology, globalisation and economic and bureaucratic rationalism. In the marginal currents we find the under-employed and the unemployed and marginal issues relating to housing, the black economy, poverty and the survival of rural communities. The data also revealed a marginal tributary running into the river. This tributary shows that social cohesion is still a part of life in ‘new times’, albeit a marginalised part. The dominant and marginal currents in social justice in ‘new times’ reveal changes at a deep cultural level. Social justice in ‘new times’ is set within the limits provided by economic rationalism. Such a position is closely linked to the rise of liberal democracy as a political ideology. A rise which has been on a global scale. This valorizes the individual as compared with the group, and the family as compared to the social whole, within the context of expanded economic groupings and markets. Such an ideological position sees the role of the state as providing the ‘legitimising muscle’ to advance the cause of individuals and their families as compared to larger social groupings. These perceptions were applied in Australia, even under a Labor Government. In this sense social justice policies in ‘new times’ are ideological, they act as a political lever to legitimate economic restructuring. They are policies designed to carry disparate groups forward and together on a common wave of economic reform. They are used to ‘sell’ economic reform as being ‘good’ for all of society. Against the backdrop of economic rationalism and liberal democratic ideals there emerges a language geared to the production of an economically viable self, self image, self identity, self esteem and self confidence. As a result, the sense of identity as ‘social’ is lost from view. This thesis argues that what is needed is a new way of looking at social justice in education. A way that reaches beyond the solutions forwarded by the political Left and the Right. It is about the development of an understanding of the way in which an assimilation of the hyper individual and the social group can result in the emergence of the socially responsible individual. This is a cultural shift that sees the individual/society dualism presented in a new way. The categories enter into a new relationship where the balance shifts away from the individual towards society. A shift to a culture where the individual’s rights and responsibilities are respected within a social whole. Such a cultural shift would result in a curriculum which would build social identity, promoted socially responsible independent thought and make space for creativity and the aesthetic. A ‘curriculum for social responsibility’ would be a socially just curriculum.

A comparison of the socio-cultural influences on body size perceptions and values among European Australian and Indigenous Fijian adolescent girls

Western women are experiencing increases in the prevalence of overweight and obesity despite valuing slimness as ideal and equating thinness with attractiveness and beauty. Pacific populations are also experiencing high prevalence rates of overweight and obesity. A lage body size, however, has many positive connotations among pacific populations that stem from rich cultural practices such as feasts and deliberate fattening of women. There appears to be many sociocultural factors however, such as images of the slim ideal portrayed in Western media, influencing body image concerns that are shared between the two groups. A qualitative study involving semi-structured interviews was conducted to examine and compare the sociocultural influences on body size perceptionsand values. Participants include 16 European Australian and 16 Indigenous Fijian adolescent girls aged between 15 and 17 years. Inductive thematic analysis and analytical induction were qualitativemethods employed to facilitate interpretation of the findings. Preliminary findings suggest that Fijian adolescent girls experience greater conflict than European Australian girls about the desired body size endorsed in their community. Results also suggest that Indigenous Fijian girls place less importance than Australian girls on manipulating their body to achieve a specific ideal. Specific results of this study are reviewed and recommendations for future research are discussed.

Diverse approaches : a study of Australian journalism educators' use of web-based curriculum modules for reporting cultural difference

The Reporting Diversity website provides four curriculum modules to assist journalism educators to teach students about the issues and practice of reporting on cultural difference. The researchers co-ordinated the second round of trials of these resources in 2009, which involved the participation of academics and students from five Australian universities. A further 30 academics were surveyed to gauge their level of awareness of the materials. This paper reports on the educators’ evaluation of the resources and reveals the innovative ways in which the modules are being used and adapted in different classroom settings. The researchers argue that sharing different teaching approaches to the materials through the Reporting Diversity website would assist other academics to adapt the resources for their own use.

The shifting ground and context of Australian multiculturalism

The thesis argues against positivistic accounts of multiculturalism's continuing failure to secure popular acceptance, suggesting that a comprehensive understanding of this phenomenon must take account of both changes in the theoretical or normative content of its formal policy texts and a range of contextual factors.

Celluloid dreaming : cultural myths and landscape in Australian film 1970-1990

Examines the way in which cultural myths in selected Australian feature films of the 1970s and 1980s reflect changing attitudes towards nationalism, Australian identity, gender roles, mateship and how the Australian settler culture defines (or fails to define) its relationship with indigenous Australians.

Homophobic bullying and human rights : non-deficit approaches in queer youth wellbeing policy and practice

This chapter is concerned with ways for improving the capacity of school communities to provide queer young people with stimulating educational experiences that productively engage with the realities of their lives and which promote and enhance their wellbeing. By "queer" or "LBGTI" I mean to refer to all of those young people who do not conform to prevailing expectations regarding gender and sexual identity and behaviours, those young people who may be lesbian,gay, bisexual, transgender or intersexual (lGBTI), as well as all of those young people who have an association with gender and sexual diversity (for example, the straight fey boy who gets called a poofta; the teenage girl with lesbian parents, etc.). Methodologically, this chapter draws on a tradition of Foucauldian cultural analysis which acknowledges that gender and sexual identities are not stable or fixed, but that they are generated by influential discourses (e.g. my identity as a "man" in Melbourne today is mediated by contemporary discourses of masculinity, of Australianness, of class and so on) (for example, see Foucault 1984, 1990, 1992 and 1998).

This chapter argues that conventional approaches to school improvement for queer students normally focus on strategies for reducing the victimisation of teenage homosexuals, and that such strategies rely on dominant discourses of safety and bullying. I examine a recent example of this policy approach and use it as a starting point for considering the benefits and the constraints of a victim-based approach to queer youth wellbeing policy. The chapter then moves into a discussion about the recent introduction of human rights legislation in Victoria and how this can assist a move in policy and practice towards a more positive and diffuse engagement with gender and sexual diversity.

Encouraging high expectation entrepreneurship : the implications of Australian policy practices

Recent studies have shown the important roles that new high growth firms can play in job creation and economic development. This paper reviews the positioning of present Australian government policies and programs that intend to be supportive of the development of more high growth businesses; that is those that employ greater than twenty persons. The research explores the environments of a group of new high growth Australian firms and the roles that the various identified government support initiatives have played in their development. The paper also draws on recent research on survival and growth patterns of spin-off companies generated by publicly funded research agencies to map the government support initiatives with the different stages of the high growth business life cycle. The paper reviews issues in the Australian business environment that may have affected the rate of generation of new high growth firms. Of particular relevance has been the progressive freeing up of the Australian labour market and a greater resource allocation to research commercialisation by publicly funded research providers. The analysis has finally separately considered how to produce and support more founders of such high growth firms, their future chief executive officers, the specialist consultants and other professional support people and issues related to access to finance that such firms will need. The research findings draw attention to the important role of government financial support for industry research, particularly at the point where the first product is in the market and resources are scarce. At this point support is vital both to increase the market penetration of the core product and for R&D for product customisation and increasing the product range.