Uncharted Waters: Influencing Practice Through a Life Course Approach: How Caregivers' Life Experience Can Influence the Care They Give to the Elderly at the End of Life

This project originates from my experience as a Palliative Care Nurse Specialist Educator working from a hospice environment. Observations and collaborative partnerships with staff in Aged Care Facilities provided insight into the palliative care needs of the residents at the end-of-life. Care Assistants (caregivers) provide the majority of direct care and spend most time with residents, with little training for providing that care, to residents with increasingly complex needs. A two phase exploratory descriptive project was designed using the life course research paradigm and life story narrative research to consider what life experience caregivers brought to their caregiving role in an Aged Care Facility in New Zealand and what influence education had on their work life. In the first phase a focus group, following education and the implementation of the Liverpool Care Pathway, was conducted and themes identified from an interdisciplinary staff team discussion. In phase two of the project four of the caregivers participated in a life story interview. The thematic analysis of these transcripts provided insight into the four caregivers' life experience. A novel method termed poetic condensation was used in the study to identify the essence of each person's life story. The researcher then reflected on each of the four life stories and identified the turning point in the person's life and a caring moment from the transcript. The discussion in the thesis reveals the impact of the education sessions and implementation of the Liverpool Care Pathway on the caregivers' practice and how this became a turning point in the delivery of care for the elderly residents particularly those who were dying in the Aged Care Facility. The researcher concludes the thesis by recognizing that her role as a palliative care clinical nurse specialist and educator is necessary to transfer specialist end-of-life knowledge and mentor staff as they shape best end-of-life practice

Holocene glacial activity in Mt Cook National Park New Zealand: The use of multi-parameter dating techniques to define glacial moraine chronologies

Holocene glacial moraines in Mt Cook National Park are re-dated by multi-parameter dating techniques. The deposits from six main valley glaciers were examined. In earlier studies by other workers the glacial moraine chronology of three of these valleys had been specified using radiocarbon, historical and lichen dating. Results from the present study are compared with this earlier work. A chronology of glacial events is here defined using historical, radiocarbon and rock weathering rind thickness dating. In addition, post-depositional surface modifications are described using changes in plant development, lichen growth and soil properties. The more precise dating methods delineate up to fifteen separate glacial expansion phases during the last 10 000 years. The weathering rind chronology defines glacial events around 7200,4200,3790,3350,2940,2540,2160,1830,1490, 1150,840,580,340,135 and <100 years ago. The chronology is strongly correlated with the radiocarbon dated glacial sequence; 8000, c.7000, 4200-4000, 3400, 2800, 2500, 2200- 2100, 1800-1600, 1100-1000, 800-700, 340 and 250 yr B.P. In recent historical times the glacial record is characterised by a number of local,minor advances prior to 1900, followed by a general still-stand until about 1930-40. During the last forty years all of the glaciers have been retreating. The widespread glacier recession supports evidence of a climatic warming in New Zealand since about 1930 which has intensified in the last thirty years. The Mt Cook glacial moraine chronology shows good agreement with the Holocene glacial record described from elsewhere in the Southern Alps of the South Island, New Zealand. A brief comparison with events associated with cool climate periods from elsewhere in the Southern Hemisphere demonstrates a similarity with events in South America, New Guinea, Australia and Antarctica. The present study indicates the need for revision of the original Mt Cook glacial moraine chronology which had implied extensive glacial expansion around the 17th century and which had grouped all of the events listed above as having formed in the last 1000 years

Soil formation on Holocene moraines in the cirque de Troumouse, Pyrenees

Factors affecting rates and degree of soil formation on Holocene moraines are discussed with reference to moraine sequences in the Cirque de Troumouse, French Pyrenees. In particular, the role of time, slope position and post-depositional history are evaluated for three moraines ranging in age from c. 5000 to c. 1000 yr BP. Soil profile development, as determined by visual criteria, indicates differences in soil development between moraines of different age as well as between soils developed on the same moraine but occupying different slope positions. Particle size analysis and soil chemical analyses confirm that microtopography exerts a strong control on the extent and rate of soil formation, and must therefore be considered when sampling and describing soil chronosequences on glacial moraines.[es] Se discuten los factores que afectan a las tasas y al grado de formación del suelo en morrenas Holocenas, con referencia a la secuencia de morrenas en el Circo de Troumouse, Pirineo francés. En particular, se evalúa el papel del tiempo, la posición de la pendiente y la historia postdeposicional para tres morrenas ordenadas en edad desde c. 5000 a c. 1000 años BP. El desarrollo del perfil del suelo, determinado por criterios visuales, indica diferencias de desarrollo del suelo entre morrenas de diferente edad así como entre suelos desarrollados en la misma morrena, pero ocupando diferentes posiciones de la pendiente. Análisis granulométricos y químicos del suelo confirman que la microtopografía ejerce un fuerte control en la extensión y en la tasa de formación del suelo y, por tanto, deberla ser tenida en cuenta en los muéstreos y descripciones de las cronosecuencias del suelo en morrenas glaciares. [fr] On discute les facteurs qui affectent les taux et le degré de formation du sol en moraines Holocènes, avec référence à la séquence de moraines du Cirque de Troumouse, Pyrénées français. En particulier, on évalue le rôle du temps, la position de la pente et l'histoire postdépositionelle pour trois moraines ordonnées chronologiquement de c. 5000 à 1000 ans av. J.C.. Le développement du profil du sol, déterminé selon des critères visuels, ' signale des différences de développement du sol entre des moraines d'âge différent de même qu'entre des sols formés dans la même moraine, mais qui occupent différentes positions de la pente. Des analyses granulométriques et chimiques du sol confirment que la microtopographie exerce une forte influence sur l'étendue et les taux de formation du sol et par conséquent, elle devrait entrer en ligne de compte dans les échantillonnages et les descriptions des chronoséquences du sol en moraines glaciaires

Rockfalls and glacier contraction: Cirque de Troumouse, French Pyrenees

The incidence of rockfalls within the Cirque de Troumouse appears to have been triggered by ice wastage and the resultant geomorphological pattern of rockfall deposits affords an insight into the migration of headwall weathering zones. Observations of the rockfall deposits indicate clear geological controls which maybe directly related to the exposure of the headwall zone during phases of glacier wastage[es] Las caldas de piedras en el Circo de Troumouse parecen haber sido desencadenadas por la acción del hielo, y el modelo geomorfológico de depósitos de bloques resultante proporciona una idea sobre la migración de las zonas de meteorización en las paredes. Las observaciones de tales depósitos indican la existencia de claros controles geológicos que pueden relacionarse directamente con la exposición de la pared durante las fases de fusión glaciar. [fr] Les chutes des pierres dans le cirque de Troumouse paraissent avoir été déclenchées par l'action de la glace, et le modèle géomorphologique des dépôts de blocs résultant donne une idée de la migration des zones de météorisation dans les parois. Les observations de ces dépôts indiquent l'existence de contrôles géologiques très clairs qui peuvent être directement liés à l'exposition de la paroi durant les phases de fusion glaciaire

Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis

Background: There is increasing interest in the role of �self-management� interventions to support the management of long-term conditions in health service settings. Self-management may include patient education, support for decision-making, self-monitoring and psychological and social support. Self-management support has potential to improve the efficiency of health services by reducing other forms of utilisation (such as primary care or hospital use), but a shift to self-management may lead to negative outcomes, such as patients who feel more anxious about their health, are less able to cope, or who receive worse quality of care, all of which may impact on their health and quality of life. We sought to determine which models of self-management support are associated with significant reductions in health services utilisation without compromising outcomes among patients with long-term conditions. Methods: We used systematic review with meta-analysis. We included randomised controlled trials in patients with long-term conditions which included self-management support interventions and reported measures of service utilisation or costs, as well as measures of health outcomes (standardized disease specific quality of life, generic quality of life, or depression/anxiety).We searched multiple databases (CENTRAL, CINAHL, Econlit, EMBASE, HEED, MEDLINE, NHS EED and PsycINFO) and the reference lists of published reviews. We calculated effects sizes for both outcomes and costs, and presented the results in permutation plots, as well as conventional meta-analyses. Results: We included 184 studies. Self-management support was associated with small but significant improvements in health outcomes, with the best evidence of effectiveness in patients with diabetic, respiratory, cardiovascular and mental health conditions. Only a minority of self-management support interventions reported reductions in health care utilisation in association with decrements in health. Evidence for reductions in utilisation associated with self-management support was strongest in respiratory and cardiovascular problems. Studies at higher risk of bias were more likely to report benefits. Conclusions: Self-management support interventions can reduce health service utilization without compromising patient health outcomes, although effects were generally small, and the evidence was strongest in respiratory and cardiovascular disorders. Further work is needed to determine which components of self-management support are most effective

Uncharted Waters: Influencing Practice Through a Life Course Approach: How Caregivers' Life Experience Can Influence the Care They Give to the Elderly at the End of Life

This project originates from my experience as a Palliative Care Nurse Specialist Educator working from a hospice environment. Observations and collaborative partnerships with staff in Aged Care Facilities provided insight into the palliative care needs of the residents at the end-of-life. Care Assistants (caregivers) provide the majority of direct care and spend most time with residents, with little training for providing that care, to residents with increasingly complex needs. A two phase exploratory descriptive project was designed using the life course research paradigm and life story narrative research to consider what life experience caregivers brought to their caregiving role in an Aged Care Facility in New Zealand and what influence education had on their work life. In the first phase a focus group, following education and the implementation of the Liverpool Care Pathway, was conducted and themes identified from an interdisciplinary staff team discussion. In phase two of the project four of the caregivers participated in a life story interview. The thematic analysis of these transcripts provided insight into the four caregivers' life experience. A novel method termed poetic condensation was used in the study to identify the essence of each person's life story. The researcher then reflected on each of the four life stories and identified the turning point in the person's life and a caring moment from the transcript. The discussion in the thesis reveals the impact of the education sessions and implementation of the Liverpool Care Pathway on the caregivers' practice and how this became a turning point in the delivery of care for the elderly residents particularly those who were dying in the Aged Care Facility. The researcher concludes the thesis by recognizing that her role as a palliative care clinical nurse specialist and educator is necessary to transfer specialist end-of-life knowledge and mentor staff as they shape best end-of-life practice.</p

Uncharted Waters: Influencing Practice Through a Life Course Approach: How Caregivers' Life Experience Can Influence the Care They Give to the Elderly at the End of Life

This project originates from my experience as a Palliative Care Nurse Specialist Educator working from a hospice environment. Observations and collaborative partnerships with staff in Aged Care Facilities provided insight into the palliative care needs of the residents at the end-of-life. Care Assistants (caregivers) provide the majority of direct care and spend most time with residents, with little training for providing that care, to residents with increasingly complex needs. A two phase exploratory descriptive project was designed using the life course research paradigm and life story narrative research to consider what life experience caregivers brought to their caregiving role in an Aged Care Facility in New Zealand and what influence education had on their work life. In the first phase a focus group, following education and the implementation of the Liverpool Care Pathway, was conducted and themes identified from an interdisciplinary staff team discussion. In phase two of the project four of the caregivers participated in a life story interview. The thematic analysis of these transcripts provided insight into the four caregivers' life experience. A novel method termed poetic condensation was used in the study to identify the essence of each person's life story. The researcher then reflected on each of the four life stories and identified the turning point in the person's life and a caring moment from the transcript. The discussion in the thesis reveals the impact of the education sessions and implementation of the Liverpool Care Pathway on the caregivers' practice and how this became a turning point in the delivery of care for the elderly residents particularly those who were dying in the Aged Care Facility. The researcher concludes the thesis by recognizing that her role as a palliative care clinical nurse specialist and educator is necessary to transfer specialist end-of-life knowledge and mentor staff as they shape best end-of-life practice