The quality of the physical environment and its association with activities and well-being among older people in residential care facilities

The physical environment can influence older people’s health and well-being, and is often mentioned as being an important factor for person-centred care. Due to high levels of frail health, many older people spend a majority of their time within care facilities and depend on the physical environment for support in their daily life. However, the quality of the physical environment is rarely evaluated, and knowledge is sparse in terms of how well the environment meets the needs of older people. This is partly due to the lack of valid and reliable instruments that could provide important information on environmental quality. Aim: The aim of this thesis was to study the quality of the physical environment in Swedish care facilities for older people, and how it relates to residents’ activities and well-being. Methods: The thesis comprises four papers where both qualitative and quantitative methods were used. Study I involved the translation and adaptation of the Sheffield Care Environment Assessment Matrix (SCEAM) into a Swedish version (S-SCEAM). Several methods were used including forward and backward translation, test of validity via expert consultation and reliability tests. In Study II, S-SCEAM was used to assess the quality of the environment, and descriptive data were collected from 20 purposively sampled residential care facilities (RCFs). Study III was a comparative case study conducted at two RCFs using observations, interviews and S-SCEAM to examine how the physical environment relates to older people’s activities and interactions. In study IV, multilevel modeling was used to determine the association between the quality of the physical environment and the psychological and social well-being of older people living in RCFs. The data in the thesis were analysed using qualitative content analysis, and descriptive, bivariate and multilevel statistics. Results: A specific result was the production of the Swedish version of SCEAM. The instrument contains 210 items structured into eight domains reflecting the needs of older people. When using S-SCEAM, the results showed a substantial variation in the quality of the physical environment between and within RCFs. In general, private apartments and dining areas had high quality, whereas overall building layout and outdoor areas had lower quality. Also, older people’s safety was supported in the majority of facilities, whereas cognitive support and privacy had lower quality. Further, the results showed that environmental quality in terms of cognitive support was associated with residents’ social well-being. Specific environmental features, such as building design and space size, were also noted, through observation, as influencing residents’ activities, and several barriers were found that seemed to restrict residents’ full use of the environment. Conclusions: This thesis contributes to the growing evidence-based design field. The S-SCEAM can be used in future research on the association between the environment and people’s health and well-being. The instrument could also serve as a guide in the planning and design process of new RCFs.

Circles of care : should community development redefine the practice of palliative care?

Specialist palliative care, within hospices in particular, has historically led and set the standard for caring for patients at end of life. The focus of this care has been mostly for patients with cancer. More recently, health and social care services have been developing equality of care for all patients approaching end of life. This has mostly been done in the context of a service delivery approach to care whereby services have become increasingly expert in identifying health and social care need and meeting this need with professional services. This model of patient centred care, with the impeccable assessment and treatment of physical, social, psychological and spiritual need, predominantly worked very well for the latter part of the 20th century. Over the last 13 years, however, there have been several international examples of community development approaches to end of life care. The patient centred model of care has limitations when there is a fundamental lack of integrated community policy, development and resourcing. Within this article, we propose a model of care which identifies a person with an illness at the centre of a network which includes inner and outer networks, communities and service delivery organisations. All of these are underpinned by policy development, supporting the overall structure. Adoption of this model would allow individuals, communities, service delivery organisations and policy makers to work together to provide end of life care that enhances value and meaning for people at end of life, both patients and communities alike.

Australian patients using a cardiac-diabetes web-based intervention program: Contributions to person-centered clinical practice

Rationale, aims and objectives: Patients with both cardiac disease and diabetes have poorer health outcomes than patients with only one chronic condition. While evidence indicates that internet based interventions may improve health outcomes for patients with a chronic disease, there is no literature on internet programs specific to cardiac patients with comorbid diabetes. Therefore this study aimed to develop a specific web-based program, then to explore patients’ perspectives on the usefulness of a new program. Methods: The interpretive approach using semi-structured interviews on a purposive sample of eligible patients with type 2 diabetes and a cardiac condition in a metropolitan hospital in Brisbane, Australia. Thematic analysis was undertaken to describe the perceived usefulness of a newly developed Heart2heart webpage. Results: Themes identified included confidence in hospital health professionals and reliance on doctors to manage conditions. Patients found the webpage useful for managing their conditions at home. Conclusions: The new Heart2heart webpage provided a positive and useful resource. Further research on to determine the potential influence of this resource on patients’ self-management behaviours is paramount. Implications for practice include using multimedia strategies for providing information to patients’ comorbidities of cardiac disease and type 2 diabetes, and further development on enhancement of such strategies

Creative leadership & communities of practice

This Second Wave presentation focused on 'Creative Leadership and Communities of Practice', with particular reference to issues of trust affecting young people, unemployment and wider uncertainties in an economic recession when people were facing job cuts and in a social environment characterised by cynicism and a downturn in trust. Young people who join Second Wave are brought into a community of practice (CoP) (Lave and Wenger, 1991; Wenger, 1999) involving a dynamic, fluid process which is distinctive in its transformative power to change people's lives. The philosophy behind this involves Dewey's notion of the 'active self' (Dewey, 1916) and the theories of 'social constructivism' (Vygotsky, 1978). The process fosters trust, confidence and social learning (Bandura, 1977; Vygotsky, 1978) in which young people join in with a dialogue involving participation in the youth-centred creative space. The 'border zone' (Heath, 1994) in that creative space enables young people to connect with each other in the specialist field of youth arts. The youth-centred partnerships involved lead to greater confidence and development in a range of important artistic, social, cognitive and emotional skills and opportunities. Ultimately, the young person may become engaged in multi-agency working with Second Wave's external partners. Throughout all of these processes, young people are encouraged progressively to develop a more 'active self' to engage proactively with many different beneficial opportunities relating to the performing arts. In an era in which there has been a loss of trust in public life this is particularly important. If trust is defined in part as a belief in the honesty, competence and benevolence of others, it tends to act like 'social glue', cushioning difficult situations and enabling actions to take place easily that otherwise would not be permissible. The Edelman Trust Barometer for 2009 has recorded a marked diminution of trust in corporations, businesses and government, as a result of the credit crunch. While the US and parts of Europe were showing recovery from a generalised loss of trust by mid-year 2009, the UK had not. Social attitudes in Britain may be hardening - from being a nation of sceptics we may be becoming a nation of cynics: for example, only 13% of the population surveyed by Edelman trust politicians to tell the truth. In this situation, there is a need to promote positive measures to build trust. The presentation aims described key aspects of Second Wave's approach to identify and disseminate its model of good practice to make this more explicit and accessible to others. It is with awareness of the profoundly challenging circumstances facing young people, particularly but not exclusively in inner city urban areas such as Deptford, and the valuable contribution youth arts work can make to their well-being and development, that the presentation was carried out. In an era of generalised mistrust, the work done at Second Wave is crucial in empowering and supporting young people to find a positive and creative direction as part of the community.

Letting go : a self-study utilizing critical literacy as method in improving my practice /

This is a Self-study about my role as a teacher, driven by the question: "How do I improve my practice?" (Whitehead, 1989)? In this study, I explored the discomfort that I had with the way that I had been teaching. Specifically, I worked to uncover the reasons behind my obsessive (mis)management of my students. I wrote of how I came to give my Self permission for this critique: how I came to know that all knowledge is a construction, and that my practice, too, is a construction. I grounded this journey within my experiences. I constructed these experiences in narrative fomi in order to reach a greater understanding of how I came to be the teacher I initially was. I explored metaphors that impacted my practice, re-constructed them, and saw more clearly the assumptions and influences that have guided my teaching. I centred my inquiry into my teaching within an Action Reflection methodology, bon-owing Jack Whitehead's (1989) term to describe my version of Action Research. I relied upon the embedded cyclical pattern of Action Reflection to understand my teaching Self: beginning from a critical moment, reflecting upon it, and then taking appropriate action, and continuing in this way, working to improve my practice. To understand these critical moments, I developed a personal definition of critical literacy. I then tumed this definition inward. In treating my practice as a textual production, I applied critical literacy as a framework in coming to know and understand the construction that is my teaching. I grounded my thesis journey within my Self, positioning my study within my experiences of being a grade 1 teacher struggling to teach critical literacy. I then repositioned my journey to that of a grade 1 teacher struggling to use critical literacy to improve my practice. This journey, then, is about the transition from critical literacyit as-subject to critical literacy-as-instmctional-method in improving my practice. I joumeyed inwards, using a critical moment to build new understandings, leading me to the next critical moment, and continued in this cyclical way. I worked in this meandering yet deliberate way to reach a new place in my teaching: one that is more inclusive of all the voices in my room. I concluded my journey with a beginning: a beginning of re-visioning my practice. In telling the stories of my journey, of my teaching, of my experiences, I changed into the teacher that I am more comfortable with. I've come to the frightening conclusion that I am the decisive element in the classroom. It's my personal approach that creates the climate. It's my daily mood that makes the weather As a teacher, I possess a tremendous power to make a person's life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humour, hurt or heal. In all situations, it is my response that decides whether a crisis will be escalated or de-escalated and a person humanized or de-humanized. (Ginott, as cited in Buscaglia, 2002, p. 22)

Discussions that work : task-centred fluency practice.

Este recurso trata de un aspecto particular de la enseñanza del inglés como lengua extranjera: la práctica de la fluidez . Sugiere algunas formas en que los estudiantes pueden ser inducidos a hablar en el aula, utilizando el lenguaje de forma creativa, a propósito, y de forma individual. El vehículo de esa utilización se define, en un sentido muy amplio de la palabra, como la discusión. La primera parte del recurso trata acerca de una serie de elementos que son esenciales para una buena discusión: algunos de ellos son bien conocidos: temas interesantes, trabajo en grupo, juego de roles, mientras que otros han sido relativamente descuidados: la como enfocar la tarea, el proceso de la organización. La segunda parte consta de unos cincuenta ejemplos prácticos que van desde lo más sencillo a lo complejo y, por lo tanto, se pueden usar con una amplia gama de estudiantes, desde la enseñanza elemental hasta la enseñanza secundaria y de adultos.

Reconstructing child welfare through participatory and child centred professional practice

This questionnaire study examined the adjustment of 245 lone-parenting women following marital separation. A composite model included intrapsychic variables as intervening between demographic and contextual variables and adjustment (life satisfaction). Regression analyses showed that the demographic and contextual variables were partially mediated by the intrapsychic variables. The path model indicated that the intrapsychic variables (sense of coherence, control, depression, and grief) had a direct impact on life satisfaction and that there was an indirect path for depression through sense of coherence (SOC) and control. It was concluded that the intrapsychic variables had a more powerful relationship with women's post-separation life satisfaction than did the demographic/contextual variables. Social implications and recommendations for future policy are considered.

Reconstructing child welfare through participatory and child-centred professional practice : a conceptual approach

The 'child' in child welfare/protection is seen as a dependent waif and an object of interest, on whose behalf adults speak and act. An alternative perspective has argued for child-centredness, and includes concepts of child liberation, rights and citizenship. Policymakers and practitioners who may accept the underlying principles may be concerned about the appropriateness and applicability of such principles in relation to practice with children and their parents in child welfare/protection cases. This paper discusses a conceptual framework for research that aims to explore participatory and child-centred professional practice by critically evaluating and developing, for professional practice, the practical meanings of 'participatory' and 'children as citizens'. We do not present research outcomes based on empirical data; instead, we present our conceptual framework as the first stage of research in progress into participatory and child-centred professional practice.

Student centred approaches : teachers' learning and practice

Student-centred approaches to teaching and learning in mathematics is one of the reforms currently being advocated and implemented to improve mathematics outcomes for students from low SES backgrounds. The models, meanings and practices of student-centred approaches explored in this paper reveal that a constructivist model of student-centred teaching and learning is being promoted and implemented with some success. The ways in which teachers and leaders are being supported through network and school-based professional learning are described.