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Senior Project submitted to The Division of Languages and Literature of Bard College

The Peace Accord, Cross-Community Programs and the Implications of the British Exit (Brexit)

On June 23rd 2016 the United Kingdom voted to leave the European Union. However, Northern Ireland voted to remain, substantiating old divisions. Protestants voted to leave and Catholics voted to stay. This article will discuss the implications of Brexit to the 1998 Peace Accord and cross community programs in Northern Ireland, specifically the Ulster Project (UPI). UPI was created to increase religious, social, and political tolerance for differing religions and cultures, as well as foster increased good will between Protestants and Catholics. Brexit will have significant implications to the work of cross-community programming and the 1998 Peace Accord

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

An evaluation of aged-care workers' knowledge of and attitudes towards the palliative approach

This study, a cross-sectional survey, evaluated the knowledge of the palliative approach to care of an entire care workforce in an Australian residential aged-care organization (n = 116, 30% response rate). Knowledge deficits were found at all staff levels: RNs lacked a full comprehension of pain and symptom management, and personal care attendants’ knowledge scores were not statistically different from those of ancillary staff. RN division 1 reported a more positive attitude toward caring for dying patients than other staff groups. Increasing experience in the field was found to be the main determinant of knowledge of, and attitudes toward, the palliative approach, while increasing hours of palliative care education and higher post-school educational level conferred some benefit. Study findings provide strong impetus for education in the palliative approach to care for the entire interdisciplinary team. With targeted education and support, older residents’ needs for a palliative approach to care can be identified by all members of the care team, and appropriate response and/or referral can be achieved

Experiences of graduate registered nurses in aged care: A case study

The number of Registered Nurses (RNs) working in aged care is declining, with few new RNs choosing aged care in their graduate year. This paper describes a study exploring 11 female graduate RNs’ experiences of working in an aged care setting in Victoria, Australia to assist in informing recruitment and retention strategies in aged care. Semi-structured interviews were undertaken and thematically analysed using open coding. This paper presents findings related to the themes of ‘free choice or allocated to aged care’ ‘reasons for graduate choices’, ‘nature of aged care: a match or mismatch for graduates’, ‘lack of professional support for graduate RNs in aged care’ and ‘role confusion’. Findings supported the recruitment of graduate RNs with an initial interest in aged care into the sector. A clearer definition of the new graduate RN’s role in aged care and a standardised graduate program may assist in increasing retention of such nurses in the future

Realizing a palliative approach in dementia care: Strategies to facilitate aged care staff engagement in evidence-based practice

Background: There is growing evidence that a palliative approach to care provision for people with dementia in residential aged care facilities improves their quality of life and provides support for family members. Despite the development of Guidelines for a Palliative Approach in Residential Aged Care (hereafter the Guidelines), there is limited evidence that these have been adopted. To date, little research has been undertaken to explore processes which could assist aged care staff to develop their practice consistent with the intent of the Guidelines. Methods: This project utilized an action research method, through which staff members from a residential dementia special care unit (SCU) undertook an investigation into their practice to explore how they could develop strategies to support a palliative approach to care provision. A key focus was related to addressing the information needs of family members of residents on the SCU. Results: Aged care staff involved in this project had little understanding of available evidence that could assist them to better support family members, including the existence of the Guidelines. Through their engagement in successive action research cycles, these staff accessed evidence-based resources and developed strategies to address the information needs of family members. Conclusions: When provided with an opportunity to reflect on and critique their practice, aged care staff were better positioned to engage with evidence concerning a palliative approach and to execute change in their practice to improve care provision for family members

Residential aged-care workers and the palliative approach: Tensions in the field

Despite the recognition of the importance of the palliative approach for older adults in residential aged-care facilities, the provision of palliative care remains suboptimal. Strategies to improve palliative care education have targeted those health carers who provide direct physical care, namely, registered nurses and unlicensed personal care attendants. While ancillary (laundry, lifestyle, food services, maintenance, and administrative) staff have been identified as an important part of the aged-care team, they have been largely absent from such studies. This article reports the experiences and perceptions of palliative care by the entire care team in an Australian aged-care facility. With few exceptions, staff perceived palliative care to be synonymous with terminal care and to be primarily physically focused. Teamwork was found to be threatened by poor communication strategies between physical care and ancillary staff, with ancillary staff simultaneously reluctant to engage in, and frustrated by their exclusion from, care-related discussions. In addition to identifying key areas for education for all levels of health carers, along with the potential of focus groups as a strategy in this endeavor, this study highlights the importance of team cohesion for enacting the palliative approach in the aged-care context

A tool to aid talking about dementia and dying: Development and evaluation

Background: Health professionals often avoid talking about death and dying with patients and relatives, and this avoidance is compounded in cases of dementia by lack of knowledge of trajectory and prognosis. Unfortunately, this impacts on care, with many terminally ill dementia clients receiving inadequate palliation and excessive intervention at end-of-life. This study developed and evaluated a tool to facilitate conversations about death and dying in aged care facilities. Methods: This study utilised available best-practice evidence, feedback from aged care facility nursing and care staff and specialist input to develop the ‘discussion tool’, which was subsequently trialled and qualitatively evaluated, via thematic analysis of data from family interviews and staff diaries. The study was part of a larger mixed method study, not yet reported. The tool provided knowledge and also skills-based ‘how to’ information and specific examples of ‘what to say’. Results: The tool facilitated a more open dialogue between dementia palliation resource nurses (a role specifically developed during this project) and family members. Both resource nurses and family members gained confidence in discussing the death of their relative with dementia, and in relevant cases discussed specific decisions around future care. Family members and nurses reported satisfaction with these discussions. Conclusion: Providing specific skills-based support, such as the ‘discussion tool’ can help staff to gain confidence and change practice in situations where unfamiliar and uncomfortable practices might normally be avoided. As our populations age, health professionals will increasingly need to be able to openly discuss care options towards end-of-life